PFLA Membership Application Form

First Name *

Last Name *

Position/Title *

Department *

(Please enter your OSU College or Department)

Email Address *

Membership Type *

New

Renewal

Membership Status *

Active (professional faculty)

Associate (classified staff and other interested parties)

Please select one of the following options for payment. If you choose to pay via check, cash, or Venmo, payment instructions will be emailed to you.

Payment Method *

My department will pay my $20 PFLA membership fee as a professional development expense (If selected, a box will appear below for the OSU to charge.)

I will pay my own $20 PFLA membership fee via check, cash, or Venmo.

I will pay what I can for my PFLA membership fee via check, cash, or Venmo (If selected, a box will appear below for the amount.)

I will volunteer with PFLA in lieu of paying a membership fee, as a member of the Board or Professional Development Committee or as a volunteer for special events.

Amount *

Index *

Do you want to be involved with PFLA beyond just being a member? If so, check areas of interest to you.

Involvement

If you selected other above, please list interests

(If you selected "Other" above, please list interests)

Professional Development programs have a PFLA focus. Please suggest topics/speakers for future PFLA programs.

Professional Development Suggestions

Professional Faculty Leadership Association

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