First Name:_________________________ Last Name:_______________________________ 

Street Address:_______________________________________________________________ 

City: _______________________________ State: _____ Zip: ______________________ 

Home Phone:_____________________________ Office Phone: _______________________ 

Gender: ___ Male     ___ Female

Does Your Employer Pay Your Dues?  ___ Yes     ___ No

Company Name:_________________________________________________________________ 

Street Address:_______________________________________________________________ 

City: _______________________________ State: _____ Zip: ______________________ 

I would prefer to receive mailings at (check one):     ___ Home     ___ Office

_____________________________________ 

Date Entered Current Degree Program (MM/YY): _______

Expected Graduation Date (MM/YY):            _______

Anticipated Degree: ________________________________

Name of College or University, City and State: _______________________________ 

Major Subject or Program Sequence: ___________________________________________ 

Currently Held Degree       Graduation -- Mo/Yr. 

_____________________               _____

_____________________               _____


College/University/Division/City/State         Major Subject/Program Sequence
______________________________________         ______________________________ 

______________________________________         ______________________________ 

A. American Indian or Alaskan Native ___     B. Asian or Pacific Islander ___

C. African-American                  ___     D. Chicano/Mexican-American  ___

E. Puerto Rican                      ___     F. Other Hispanic/Latino     ___

G. White (not Hispanic/Latino)       ___ 

REGULAR MEMBERSHIP in NASW is open to anyone who has received an undergraduate or graduate degree from a Council on Social Work Education (CSWE) accredited or recognized program	____ $160.00 Regular
STUDENT MEMBERSHIP is open to anyone currently enrolled in a CSWE accredited social work degree program, or a program approved for candicacy. Students who join while they are undergraduate or graduate degree candidates pay one-half of the regular member dues for the two years immediately following graduation.	STUDENTS ____ $40.00 CSWE Masters _____ $40.00 CSWE Bachelors ____ $40.00 CSWE Site Team
RETIRED/UNEMPLOYED/DOCTORAL CANDIDATE MEMBERSHIP Reduced rates are available to individuals who are elibible for regular membership and are retired or unemployed, that is, totally unsalariedin any field, or to degree candidates in social work doctoral programs.	____ $49.00 Retired ____ $49.00 Unemployed ____ $49.00 SW Doctoral Candidate
ASSOCIATE MEMBERSHIP is open to anyone currently employed in a social work capacity (not self-employed or group private practice) who holds any accredited baccalaureate or higher degree, other than in social work. Associate members are not eligible for liability insurance and may not hold national office.	____ $128.00 Associate
ACSW REINSTATEMENT Add the $20 annual fee to the membership dues and check here.	____ $20.00
FOREIGN DEGREE NASW encourages members who live outside the U.S. or who hold a degree from a university outside the U.S. Please call Membership Records 1 (800) 638-8799 for eligibility requirements.
FORMER MEMBER Yes No Prior name if different from current _____________________________________________
METHOD OF PAYMENT -- PLEASE CHECK ONE: ____ Check or money order made payable to NASW ____ NASW Visa ____ Other Visa ____ MasterCard Card Number ___________________________________ Expiration Date _________ Amount $________
Print a copy of this form, write a check covering your membership dues and mail it with this form to: NASW New York City Chapter 50 Broadway, 10th Fl. New York, NY 10004
AFFIRMATION I hereby affirm and agree that I will abide by the Code of Ethics of the association and agree to submit to proceedings for any alleged violations of the same in accordance with NASW bylaws. I further understand that falsification of the contents of this application will be grounds for rejection and/or termination of my association membership and revocation of any and all benefits resulting therefrom (see summary of code). Your signature affirms agreement with above terms and conditions _______________________________________

We would like to hear from you personally. Email us at naswnyc@naswnyc.org. We may also be reached by:

Telephone: (212) 668-0050. 
Facsimile: (212) 668-0305. 
Postal mail: NASW New York City Chapter, 50 Broadway, 10th Fl., 
New York, NY 10004. Copyright © 1998 NASW New York City Chapter