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I am not currently a member of the Hudson Mohawk ASTD, but I would like to apply now.

Areas of Expertise:
Name (first, mid. init., last):
Suffix:
Company:
Title:
Street Address:
PO Box or Suite:
City, State, Zip:
Telephone + Ext:	Ext.
Fax:
	I want to display my fax number: ("No" indicates approval for ASTD internal use only)
Email Address:
	I want to display my work email address: ("No" indicates approval for ASTD internal use only)
Website:
	I want to display my website (URL) information: ("No" indicates approval for ASTD internal use only)
Type of Business:
Type of Position:
Description:	In 75 words or less, describe your skills and highlight areas of expertise.
Category 1:
Category 2:
Category 3:
Category 4:
Category 5:
Category 6:

Home Information
I want to publicize my home address information.
Address:
City, State, Zip:
Telephone:
	I want to display my home telephone: ("No" indicates approval for ASTD internal use only)
Email Address:
	I want to display my home email address: ("No" indicates approval for ASTD internal use only)
Do you want your work address as your primary address (for our directory & mailings)? Yes No Do you want your home address as your primary address (for our directory & mailings)? Yes No