PDK International - PDK Membership Application

THE PROFESSIONAL ASSOCIATION IN EDUCATION

PDK Membership Application

Type the following information and click on the Continue to Payment button.

International Electronic Membership Application

Annual Membership Fee $40.00 (International) plus a direct regional fee ($15.00) or a local chapter fee (varying amounts). Note: A one-time $5.00 processing fee will also be assessed.

Required Fields *
Prefix	(Dr./Mr./Ms./Mrs.)
First Name *		Middle Initial
Last Name *		Suffix	(Sr., Jr., Ph.D.)
Preferred Name
Address *

City *		State/Province *
Zip/Postal Code *
Country *
Home Phone *	(XXX-XXX-XXXX)	Office Phone	Ext.
Fax		Cell Phone
Primary Email *
Secondary Email

Birthdate *	(MM/DD/CCYY)
Gender
Education
Occupation
Title
Specialty		Other
Ethnicity (optional)

Employer Name
Employer Address

Employer City		State/Province
Zip/Postal Code
Country

Would you like to sign up for PDK's Book Club? Yes No
Do you currently have a subscription to the KAPPAN journal? Yes No
If yes, what is your KAPPAN account number?
How did you hear about Phi Delta Kappa?
PDK maintains a database of information for inclusion in our online member-only membership directory. Would you like to be included in the online membership directory? Yes No If yes, please check the items you would like included in the directory. Note: Name, city, state, zip, and e-mail are included by default. Full Address Home phone Office phone Office fax Personal or business web page (URL:
Preferred Method of Communication

I would like to be affiliated with a chapter

Chapter

I would like to become a Direct Member (non-chapter affiliated)

Choices for chapter affiliation are based on locality. You are not limited to the selection of a chapter near you, however. If you would like to select a primary chapter and/or dual chapter that is unavailable from the drop-down menu, choose the Direct Member option and proceed to final payment. Once payment is received and membership is finalized, you may transfer your membership to any of PDK's almost 600 chapters. Choose Transfer Membership from the left-hand side menu options and proceed to select the chapter with which you would like to affiliate.

International Dues

Chapter Dues/Direct Regional Fee

Processing Fee

Total