SSI Enrollment Form

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SSI Enrollment Form

Great! We are happy that you have decided to join our Sound Science Initiative. The enrollment form is below. This information will enable the SSI staff to provide you the best possible service.

All SSI Members within the U.S. receive the biannual UCS magazine, Catalyst, and our quarterly newsletter, Earthwise. These publications will be sent to which ever address you note to receive correspondence.

NOTE: All information is private and confidential and will not be distributed beyond UCS without permission of the respondent.

* fields are required

Email*

Prefix

First name*

Last name*

Home Address

Address Line 1*

Address line 2

City*

State/Province*

Zip code*

Country*

Phone number

Business Address (optional)

Institution

Department

Address Line 1

Address line 2

City

State/Province

Zip code

Country

Phone number

Where should we send correspondence?

home

work

Email preference*

HTML

plain text

Professional Information

Degree

Work Sector

Discipline*

Area of Expertise*

Years in Field

Professional Title

Professional Associations

Professional awards or honors

SSI Information

I would like to receive email action alerts and updates on the following issues

Biodiversity
Climate

Many SSI members are interested in working with others in their area on special projects related to SSI issues. Can we pass along your name and e-mail address to other SSI members in your area?

yes

Where did you hear about UCS's Sound Science Initiative

Other recruitment source

Personal Information (optional)
The following information is not required for SSI participation, but will help us provide better services to you and will give us a better profile of SSI membership.

Birthday

YYYY-MM-DD

Gender

male female

Ethnicity:

Media Experience

I have written letters-to-the-editor

Yes No

I have written op-eds

Yes No

I have been interviewed for radio/TV/newspaper

Yes No

I have participated in editorial board meetings

Yes No

Advocacy Experience

I have written to/called my legislator

Yes No

I have met in person with a legislator or legislative staff

Yes No

I have given testimony at a legislative or administrative hearing

Yes No

Public Speaking Experience

I have spoken at a town meeting or other public forum

Yes No

I would be willing to speak at local or regional events

Yes No

UCS privacy statement

Page Last Revised: 02/07/07