Membership Application

Create a Login Name: Login Password: Retype Password: First Name: Middle/Initial: Last Name: Title: Company: Department: Mailing Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip Code: - Phone: Email: Web Site: Educational Background: Please list colleges/universities attended and degrees When did you start working in the PR/communications field? 2017 - present 2010-2016 2005-2009 2000-2004 1995-1999 1990-1994 1985-1989 1980-1984 1975-1979 1970-1974 1965-1969 1960-1964 Before 1960 PR Credentials: Management 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Teaching/Counseling 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Editing/Writing 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Media Relations/Publicity 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Employee Relations 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Advertising 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Financial/Investor Relations 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Government Relations 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Consumer and Community Relations 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Special Events 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PR Credentials: Other Duties PRSA National Membership? Membership: Special Interest Sections APR PRSA Fellow PRSA Officers What year range were you born? Before 1965 1966-1975 1976-1985 1986-1995 1996-2005 2006 and after Choose not to answer What gender(s) do you identify with? Which of the following best describes your sexual orientation? Which of the following best describes your race/ethnicity? Do you have any needs, physical or neurological, for which we could provide better access to events and/or services?