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Bay Area Ergonomics Roundtable - Membership Application Form
Questions about membership? Contact Kim at
ergonomicsandyou@yahoo.com
Check out our website:
https://sites.google.com/view/bayareaergonomicsroundtable/home
NOTE - membership is reserved for those who practice ergonomics, not for vendors of ergonomic products
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First Name
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Your answer
Last Name
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Your answer
Company Name
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Your answer
Address (Street)
Your answer
Address (City)
Your answer
Address (State)
Your answer
Address (Zip Code)
Your answer
Phone Number
Your answer
Email Address
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Your answer
Company Website
Your answer
Sponsoring Member or Referral Source
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Your answer
Why do you want to join BAER?
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Your answer
Professional Certifications
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Your answer
Professional Organization Memberships
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Your answer
Degrees
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Your answer
Ergonomics Experience (type & duration)
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Your answer
Ergonomics Interest Areas
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Your answer
Select a Membership Level
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Full Member (must be a practicing ergonomist or an ergonomics program manager in the San Francisco Bay Area or Silicon Valley)
Student Member (full time student or intern in Human Factors, PT, OT or related field)
Select Desired Participation (select all that apply)
*
Virtual Meeting Host (Zoom) able to host 30+ people or more for a Zoom meeting
Onsite Meeting Host (provide a meeting room for 30 people from 12 PM to 2 PM, lunch optional)
Meeting Presenter (30-min or 1-hour presentation)
Meeting Planner (meet to plan meetings)
BAER Website support
Other:
Required
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