FORM for APS-Member-Taught CLASS/WORKSHOP Listing Request

Membership REQUIREMENT *

(If you need to join APS, or renew your membership, you can do that on the “JOIN” page using the tab at the top of any website page.)

Teacher AFFIRMATION *

(You cannot request a listing for another person.)

Name *

First

Last

Your name as you wish it listed, and as your are listed in the APS Membership File

Starting Date *

(mm/dd/yy)

Ending Date *

(mm/dd/yy)

CLASS or WORKSHOP? *

(If “Other” please briefly explain in Comments at bottom of form)

Title of Class or Workshop *

Brief Title that you wish listed.

Link to full INFORMATION *

URL, email address, or phone number you wish listed for interested students to contact you or register.

Your Email Address *

(This will not be listed, but will be used if we need more information from you.)

Best phone number to CONTACT YOU *

(This will not be listed, but will be used if we need more information from you.) Please indicate if not a Cell Phone.

Comments (These are NOT published on the Listing)

(This is a place for BRIEF comments you wish to make to the webmaster. There is no place for this information on the Listing.)

Name