Associate Membership Application - African Astronomical Society

Membership Level *
Associate Membership
Title
First Name *
Middle Name
Last Name *
Date of Birth *
Gender *
Nationality *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Email *
Alternate Email
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AfAS Scientific Division Interest(s) *
Stars and planets
Galaxies
Cosmology
History of Astronomy
Astronomy and Astrophysics in general
Computation and HPC
Education and Outreach
Employer/Institution
Department/Division/Unit
Highest Qualification *
Institution where highest degree was earned *
Details of astronomy activities that show involvement in the advancement of astronomy *
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