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Thursday, September 09, 2010
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ARPAS
2441 Village Green Place, Champaign, Illinois 61822
217/356-5390
217/398-4119 (FAX)		 Submitted:
Approved
Certificate No.:

APPLICATION FOR:
Associate Membership Full Membership Graduate Student
Registered Animal Specialist (RAS) / Registered Animal Product Specialist (RAPS)
Professional Animal Scientist (PAS)

Name: 
Institution/Company:  
Address:     
                  
City: State:
Zip: Country:
Phone: FAX:
E-mail:
Citizenship: 

Advisor Confirmation for Graduate Students
Advisor Name:
Advisor Email:


_______________________________________________________
Advisor's Signature

AREA(s) OF SPECIALIZATION
(exam required in each area chosen)
1. Aquaculture
2. Beef Cattle
3. Companion Animals
4. Dairy Cattle
5. Goats
6. Horse
        7. Laboratory Animals (available soon)
8. Poultry
9. Sheep
10. Swine
11. Dairy Product Science
12. Meat Science
13. Poultry Products

 FEE
  Exam Fee $25 (Required)
(Non-refundable, the first $25 will be applied to membership (additional exam fees not applied towards dues). Minimum $25 fee must accompany exam. Balance of first year member dues will be due if exam is passed.)
  Annual Membership, $85 (Includes $25 exam fee)
(Includes access to online journal)
  Annual Membership with Paper Copy Journal, $165 (Includes $25 exam fee) US Members
(Includes 6 hard copy issues per year plus access to online journal)
  Annual Membership with Paper Copy Journal, $172 (Includes $25 exam fee) International Members
(Includes 6 hard copy issues per year plus access to online journal)
(Make check payable to ARPAS)
  Visa   MasterCard   American Express   Discover
Card #:        Exp. Date:


___________________________________________
Signature
Name to be printed on certificate:
I certify that the materials submitted in support of this application are true and correct to the best of my knowledge and that I will abide by the Code of Ethics.
Date:



___________________________________________
Applicant's signature
"I believe this person has the necessary qualifications, would uphold the ideals of the Registry, and would abide by its Code of Ethics."
Name of ARPAS Member:



___________________________________________________
Signature and Date

Must also provide the information requested on the Background Information Required for Registration Application. 
Please call the ARPAS office at 217/356-5390 for assistance if the name of an ARPAS Member is unavailable to you.

1. Educational Background
Degree
Date of Degree
Major Area
Institution
   
Degree
Date of Degree
Major Area
Institution
   
Degree
Date of Degree
Major Area
Institution

2. Experiences in Animal Science prior to obtaining last degree.

3. Positions since obtaining last degree.
Position
Dates of Employment
Responsibilities and Activities
   
Position
Dates of Employment
Responsibilities and Activities
   
Position
Dates of Employment
Responsibilities and Activities

4. Memberships in professional organizations.

5. Membership in honorary organizations.



6. Attach official transcripts of all academic credits (undergraduate and graduate).





ARPAS provides for:
 -  Recognition of expertise
-  Continuing professional development
-  Ethical standards
-  Increased public confidence

ARPAS value to users of 
-  advisors
-  products
for
-  animal care
-  nutrition
-  health



ARPAS
2441 Village Green Place,
Champaign, Illinois 61822
E-mail: arpas@assochq.org
Ph. 217.356.5390
Fax 217.398.4119

ADSA

AMSA

ASAS

ESS

PSA
ADSA AMSA ASAS ESS PSA

© 2003 American Registry Of Professional Animal Scientists
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