Chinese Scholars Association, Southern California

美國南加州華裔教授學者協會

Application 申請入會

CSA Membership Application Form

 

Please mail your check payable to CSA and this form to: Prof. Kwan Ming Chan, CSA Treasurer

P. O. Box 1953, Huntington Beach, CA 92647, USA

 

Please check: New                    Or             Renewal

Type of membership (The membership cycle is from Sept. 1 to Aug. 31):

(Please check): Regular ($25)       Lifetime ($200)     Associate ($10)      

 

1. Name (English):                                                 ___

2. Chinese  Name:___________

3. Affiliation and Title (University/organization)

______________________________________________________________________

 

4. Academic qualification, including year of degree awarded and name of universities: ______________________________________________________________________

 

Year of Ph.D., or equivalent  earned: _________________________________________________________________

 

5. Office Address: ______________________________________________________________________

 

6. Email: __________________ Website: _____________________________

 

7. Phone:  ______________________ Fax: ____________________________

 

8. Home Address (optional) :________________________________________

 

City and Zip: _______________________________

9. Past Employment (optional): Year: ________   Job Title: _____________________________________________________________

Institution: __________________     Address: _________ ____________________________________

 

10. I am interested to get involved in: (Please check as many as apply)

 

- Annual assembly and spring gathering                              - Social gatherings, open house

- Forums, symposium, seminars                                            - China tour (conference, lectures, visit)

- Publications                                                          - Webmaster

- Social science committee                                     - Science & Engineering committee

- Outreach activities                                                - Fundraising