Membership Application You will need to upload your resume at the end of this form. Thank you for taking the time to fill-up our application form! * indicates required field First Name:* Last Name:* Email:* Address:* Phone:* Current Employer Employer Name:* Your Title:* Employer Address:* Type of Business or Organization:* Education Degree & Major:* Please list organizations that you have been actively involved with. Include organization name, your role or title and dates of service.* Why are you interested in becoming a Pueblo Science member?* Skills, Experience and Interests What experience and knowledge will you bring to Pueblo Science? Please indicate your skill level in the following areas. 1. Education, instruction* High Good Some None 2. Special events organization* High Good Some None 3. Finance, accounting* High Good Some None 4. Public relations, communications* High Good Some None 5. Fund Raising* High Good Some None 6. Grant and proposal writing* High Good Some None 7. Knowledge of legislative system and government relations* High Good Some None 8. Personnel, human resources, membership recruitment* High Good Some None How do you think your membership would best benefit Pueblo Science?* Payment Membership fee I am sending a cheque of $10 payable to Pueblo Science I paid my membership fee online (Mastercard, Visa, Paypal) I am personally bringing 10$ cask to Pueblo Science office address The membership fee per year is $10, payable by cash, credit card or cheque to Pueblo Science. Pueblo Science mailing and office address: 60 St. George Street, Suite 331, Toronto, ON, M5S1A7 Canada Mailing List Yes, I would like Pueblo Science to contact me with newsletters, invitations, etc. Pueblo Science will never share your details with third parties or send unwanted communications. Linked In Yes, I would like Pueblo Science to add my Linked In account Linked In Account: Authorization and Agreement by Applicant I certify that the above statements are true and complete to the best of my knowledge. I understand that any false statement, omission or misrepresentation in my application or placement interview may result in the rejection of my application or discharge from the membership. Signature (please type your name): Date: Upload Resume:* Acceptable file types: doc,docx,pdf,rtf.Maximum file size: 1mb. CAPTCHA Code:*
