Membership Nomination Form

TO BE COMPLETED BY NOMINEE:
Before completing this section of the Membership Nomination form, read the membership information, especially the section on Nominating Procedures. When completed, the form should be signed by a Member of the Society who will act as the nominator.

1. I wish to nominate:

Name __________________________________ Present Appointment __________________________

Telephone ( ) _________________ E-mail: (distinguish "O" [oh] from "0" [zero]) ___________________

2. Mailing address (include postal code):

_____________________________________________________________

_____________________________________________________________

3. Qualifications are:

Degree	Year	Institution Granting Degree
_______	______	____________________________________________________________
_______	______	____________________________________________________________
_______	______	____________________________________________________________

4. Field(s) of research: _________________________________________________________

5. Publications:

a. Title of PhD dissertation, and reference if published: ________________________________

b. Please attach a list of the nominee’s research publications after the date of the PhD, including articles accepted for publication. The list must include a checkmark beside publications that have been refereed. When publications appear in non-English sources, provide a brief description of those sources and of their review process.

TO BE COMPLETED BY NOMINATING MEMBER

Members shall be persons qualified to conduct and to supervise scientific research in psychology or allied sciences. To be eligible for membership, a person must (a) hold the PhD degree or equivalent, (b) have published significant independent research other than the doctoral dissertation, and (c) be actively involved in scientific research in psychology or allied sciences.

Typically, a successful candidate will be at least 2 years post-PhD, will have at least four research publications in refereed journals after the date of the PhD (at least three of which are based on research subsequent to the PhD), will demonstrate clear evidence of independent scholarship, and will be engaged in scientific research.

I have read the above criteria and I certify that the nominee fulfills each of them. I have checked that the attached list of publications meets the specifications described above in 5b. I make the nomination, without qualification, to membership in the Psychonomic Society.

_______________________________________________________________
Signature of nominating member Date Name typed or printed in ink

Deadlines for receipt of applications are March 1 and September 1. Please send the ORIGINAL of this form to the Secretary-Treasurer of the Society, whose address is below.