Full Name (print) : _______________________________________

Current Position :  _______________________________________

Address 1 :  ______________________________________________

Address 2 :   _____________________________________________

City : ____________________________________________________

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Country : _________________________________________________

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Do you work on a regular basis for any media, publisher, or scientific organization? (If so, please name it, state position held, and for how long. Indicate any freelance work, too.)

What was your experience in science communication before assuming your present post? (Please give a brief outline of your career.)

List any major published works (books, scripts, etc.):

Please give any additional information you feel is relevant, i.e. membership in clubs, scientific institutions, etc. (If more space is needed, attach extra sheet.)

I, the undersigned, hereby apply for membership of the International Science Writers Association and undertake to maintain its standards of conduct, to accept its decisions, and to do all I can to advance the status of the science-writing profession.

Signed :

Date :


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                    James Cornell, Presidentr
                    International Science Writers Association
                    6666 N. Mesa View Terrrace
                   Tucson, AZ 85718
                    Telephone: (520)-529-6835

                    Email: [email protected]