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Annual Dues

	Check this box if you are an ASTD National Member

Optional Information Requested by ASTD National for Affirmative Action Purposes Only (Please check):
Gender	Male Female

Race	African-American Asian-American Caucasian Hispanic Native American

Chapter Committee(s) and Service Preference (Check any for which you would be willing to volunteer)
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How did you become aware of the ASTD-Memphis Chapter? (Please check)
	Newspaper ASTD National Other ASTD-Memphis Chapter Member Member Name

ASTD-Memphis Chapter Information Network ASTD-Memphis Chapter Information Network is designed to encourage and facilitate exchange of expertise among chapters members. If you are willing to share information with other chapter members, please identify UP TO FIVE (5) TOPICS in which you have expertise from the list on the back of the form or on the Web site. Enter the number of topics selected in the boxes below. Information may be published in the annual membership directory for member reference. HRD - Management of the HRD Function TTP - The Training Process TPT - Training Program Topics
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