Name: __________________________________________________Date: ______________________

Address: _________________________________________________________________________

_________________________________________________________________________

(please indicate home or work; street, city, state, zip/postal code and country)

Phone: (home)__________________________________(work)_________________________________

E-mail__________________________________ Fax (home) ______________(work)_______________

Current work or school affiliation:_________________________________________________________

The WSC Board of Directors has decided to release WSC member directory information, if asked for,
provided each member consents for the information to be released. In accordance with this please
indicate what information, if any, you permit to be released. If no boxes are checked, your information,
including your name, will not be released:

____work affiliation ____ address ____ home phone ____ work phone ____ email address

Please check member category and type of membership: New___ Renewal___ Lifetime____

Regular: ($45)_____ Student: ($25)_____ Lifetime: ($500 one time payment)_______

Annual dues are from January 1 to December 31 of each year, which covers the annual conference.

June Morrison Fund Donation: $_______
The Fund provides partial conference scholarships to student members in the field of criminology.

Total amount of check or money order enclosed: $______________ (payable in U.S. dollars only, please.)