EmailMe Form - SIP Membership Registration (R01.01.2021)

How did you find out about SIP?

eg: continuing member, name of person who referred you, etc.

Name *

First Last

Email *

Gender

Male

Female

Other (Specify)

Are you renewing your membership? *

No

Yes

Even if renewing your membership, we still need you to fill out the application so we can update our records. Although mailing addresses may not change too often, email, phone numbers and affiliation do. So, please bear with us and complete an updated member profile annually.

Are you subscribed to the SIP listserv? *

No

Yes

Do you want to subscribe to the SIP listserv? *

No

Yes

For issues regarding our listserv, please contact Wendy at admin@aiansip.org

Phone

### - ### - ####

(U.S. phone numbers only - see below for other)

Non-U.S. Phone Number

(If Non-U.S. number, please enter here and be sure to include country code)

Physical or Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Are you a student? *

No

Yes

Student Status

Please complete the following if you are currently a student

Degree Type

What degree are you currently working toward?

Degree Program

eg: Counseling, Education, Nursing, etc.

Personal Information

Please tell us about yourself.

Ethnic Identification *

African American / Black

Asian / Pacific Islander

Euro / American

Latino / Hispanic

Native Hawaiian

Alaskan Native*

American Indian*

Although multiple ethnicity may be applicable, please select the one that best applies to you.

*Tribal Heritage or Affiliation

If American Indian or Alaaka Native, please include your tribal heritage or affiliation here

Highest Level of Education Completed

Degree Title

eg: Clinical Psychology, Education, Nutrition, etc.

Year Awarded

A bit about you . . .

Please tell us a bit about your area/s of expertise, interests, or if you may consider joining any particular special interest groups in SIP (eg: mentorship, advocacy, crisis response, etc.). Getting to know a little about you will help those of us behind the scenes to connect you with others who may have common interest, etc. It will help us spark new relationships and knit together a stronger community.

Welcome!

Privacy/Permission *

Yes, SIP may share my contact information with discretion

No, I do not wish any of my information to be shared

We will never use your information to spam you. On occasion, however, SIP may choose to share its membership information with affiliated organizations. Know that our priority is to ensure the information you provide to us is protected, and that your privacy is respected. We take this responsibility very seriously.

Membership Type *

Regular - $50 / year

Student - $10 / year

Elder - $35 / year

* Special

For "Special" Membership, input code provided
ALL MEMBERSHIPS ARE GOOD FOR 1 YEAR

Thank You!

Your membership makes SIP possible. Your generous support helps us to help others by enabling SIP to continue its mission serving all our relations in Indian Country. Please consider making a charitable donation to SIP or the Carolyn Attneave Scholarship Fund.

Submitting your membership will take you to the payment/donation page on our website. SIP accepts payments or donations online via Paypal, or by regular mail. Your membership is not complete until we receive your payment. Mailing information can also be found on the payment page of our website.