Student Membership Application - African Astronomical Society

Membership Level *
Student 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
Mobile Number *
Please include country code
AfAS Scientific Division Interest(s) *
Stars and planets
Galaxies
Cosmology
History of Astronomy
Computation and HPC
Education and Outreach
Highest Qualification Completed *
Institution where highest degree was earned *
Qualification you are currently registered for *
Institution where you are currently registered *
Profile Image
Username *
Password *