THE WASHINGTON-BALTIMORE
CENTER
OF THE A. K. RICE INSTITUTE
Betsy
A. Hasegawa, Ed.D.
Chair, Membership Committee
2315 Eldridge Avenue
Bellingham, WA 98225
Application for Membership
Applicant’s Name __________________________________________________
Home Address ____________________________________________________
City, State, Zip ____________________________________________________
Business Address _________________________________________________
________________________________________________________________
City, State, Zip ____________________________________________________
Home Phone _________________ Business Phone __________________
Fax ________________________ E-mail __________________________
To be considered for membership, applicants
must have attended a minimum of
nine days of A. K. Rice or Tavistock Institute Group Relations conferences,
as a
member, of which at least four days was at a residential conference.
Conference Name Location Director Date
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Each applicant must arrange for two
letters of recommendation, attesting to his
or her competence and integrity. One letter must be from an A. K.
Rice Associate.
Please list the names of those providing letters of recommendation
for you.
1. ______________________________________________________________
2. ______________________________________________________________
Please provide the following information, where relevant (attach
additional sheets if necessary):
1. A.K. Rice-sponsored training activities in which you have participated:
2. Other relevant activities, e.g., courses taken, experiential
group conferences,
research activities and/or publications, organizational consultation
related to the
study of groups, teaching, etc.
3. Please write a letter describing your interest in joining the
Washington-Baltimore Center.
4. For the Membership Committee’s
awareness of your talents, skills and career
experience, please provide a copy of your resume or curriculum vita.
__________________________________
____________________
Signature Date
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