International Association for the Study of Dreams [IASD]
Affiliate Membership Form 

To become an  IASD AFFILIATE, please fill out this request form. 
You will be contacted by the IASD AFFILIATE MANAGER once your organization is 
approved and the payment link will be given. 

Mail to:   IASD Affiliate, 1672 University Ave,  Berkeley, CA, USA, 94703

[    ] New Affiliate Member or
[    ] Renewing Affiliate Member or change of address/contact information

IASD Affiliate Levels

[    ] Fewer than 150 Members ($150.00)
[    ] 150- 300 members ($250.00)
[    ]  More than 300 members ($300)
[    ] Other (explain)

Name of Affiliate Group (create one if you don't have an official name)

Name of Affiliate Contact or Leader

 Address of Affiliate Contact (include full postal address)


E-mail:
Please repeat E-mail:

Main  Phone:

Evening Phone:

Fax:

Website (of Affiliation Group, if any):


[   ] We agree to follow IASD Ethical Guidelines


[    ] Check this box if you do not want your name included for distribution on 
the IASD Membership List? 
[    ] Occasionally, IASD provides a list of current members to organizations 
who wish to market books and other dream-related materials. To remove your name 
from such a list please check this box: 

If you have other comments or communications with the Office, please include 
them here or on the back of the form.