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Membership application: Affiliate Fellow

* required fields

Contact information

First name: *
Last name: *
Middle name:  
Degrees: *
Current institution: *
Department: *
Title: *
Telephone: *
E-mail: *
Alternative Email:  

Mailing address (Please list the address where you would prefer to receive your copy of SFP's official journal, Contraception, should you be selected for membership. If you do not want a hard copy please check the “online only” check box below):

Address 1: *
Address 2:  
City: *
State: *
Region: *
Country: *
Zip: *  
Online only Contraception journal


Education
(Please fill out all fields that apply.)

Undergraduate          Institution:
  Location:
  Dates:
  Degree:

Graduate 1
not applicable
  Institution:
  Location:
  Dates:
  Degree:

Graduate 2
not applicable
  Institution:
  Location:
  Dates:
  Degree:

Medical school
not applicable
  Institution:
  Location:
  Dates:
  Degree:

Residency 1
not applicable
  Institution:
  Location:
  Dates:

Residency 2
not applicable
  Institution:
  Location:
  Dates:
(if more than 2 residency locations, please use an additional page)

Fellowship
not applicable
  Institution:
  Location:
  Dates:
 
Check here if you are currently enrolled in or completed a Fellowship in Family Planning.
 
Highest Degree:  
 
Do you currently, or are you in training to, provide clinical care?
 
Do you currently, or are you in training to, conduct research?



Criteria for Affiliate Fellowship


Post-graduate training and/or graduate degree requirement
*
In order to be eligible for Affiliate Fellowship in the Society of Family Planning, applicants must have completed a post-graduate training or graduate degree program more than five years ago. If you are currently enrolled in a program, you are not eligible for Affiliate Fellowship but you may qualify for Junior Fellowship and should use the application for Junior Fellowship instead. Please call SFP staff at (866) 584-6758 or email info@societyfp.org for more information.

I am currently enrolled in a post-graduate training or graduate degree program (residency, fellowship, graduate degree, etc).

I have completed a post-graduate training or degree program.

Please list the name of the program in which you are or were enrolled and the completion or anticipated completion date:
Program: *
Completion date: *


Sponsor requirement

Applicants must be sponsored by two SFP Fellows in good standing. Affiliate Fellows and Candidate Fellows may not serve as sponsors. SFP staff will verify sponsors before processing applications.

Name of Primary Sponsor: *

Name of Secondary Sponsor: *

Please note:  If you have published at least three (3) original research articles relating to family planning in peer-reviewed journals, are the first author of at least two (2) of those articles, and have presented an abstract at an SFP Annual Meeting,* you might qualify for Full Fellowship and should use the application for Fellowship instead. Please call SFP staff at (866) 584-6758 or email info@societyfp.org for more information.


Background information


Please list your current research interests:

Primary:       Secondary:
1.   3.
2.   4.


(mark all that apply)

       
   

Other (please specify)


What is your primary field of professional expertise or academic focus?

     
   
     

Other (please specify)

Countries you work in:


What are the primary reasons you would like to become a member of the SFP?

   
 

Other (please specify)


How did you hear about the Society of Family Planning?


*Demographics


Which category best describes your gender identity?*


Are you of Hispanic, Latino, or Spanish origin? *


Which category best describes your race*

* Will not be visible to the public


Do you have a colleague who you feel should be encouraged to apply for membership in the Society of Family Planning?  If so, please provide:

Name:
Institution:
Email address:


Please attach your current curriculum vitae:
*



*From 2005 through 2010, SFP Scientific Meetings were held annually at the Reproductive Health conference. However, as of 2011, SFP’s annual scientific meeting is held in conjunction with the annual North American Forum on Family Planning, produced by SFP and Planned Parenthood Federation of America.