SPR :: SECURE ONLINE MEMBERSHIP APPLICATION

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Membership Status (check one):
Renewing Member (Please complete this form in full to assist us in updating our records.)
New Member
Membership Type (check one):
Regular Member, ONE YEAR, 01/01/2015 - 12/31/2015  $170
Student Member, ONE YEAR, 01/01/2015 - 12/31/2015   $75
     (Includes students and post-doctoral fellows.)
     Indicate Level of Study:
      Bachelor's  Master's  PhD  Post-Doc Fellow
     Expected Date of Completion:  (MM/YYYY)
Membership Information:
First Name:
Middle Name:
Last Name:
Highest Degree:

PhD MD ScD DrPH EdD JD MS MA MSW MPH MEd MPP

MPA BA/BS Other: 

Date of Degree:
Granting Institution:
Current Employment Information:
Career Level: (check one):
Student Post-Doctoral Fellow First Yr. Professional Early Career
Mid Career Senior Other  
Employer, Institution, Organization:
Position / Title:

Division / Department:

Is this an endowed position?: Yes No

Mailing Information:
Address:
 City: State / Province
Zip / Postal Code
Country

Telephone:
Fax:
Email Address:
Select preferred Prevention Science journal subscription delivery? Electronic Print
May we post your contact information in the SPR website membership directory? Yes No
May we distribute your contact information to other SPR Members? Yes No
Would you like to be included in the Early Career Preventionist Network (ECPN) listserv? Yes No
Would you like to be included in the Diversity Network Committee (DNC) listserv? Yes No
Would you like to be included in the International Task Force (ITF) listserv? Yes No
Gender (check one):
Male Female
Ethnicity (check one - optional*):
American Indian, Native American Spanish, Hispanic, Latino
Asian, Pacific Islander White, Caucasian, European
Black, African American Other
Disabled (optional*):
Yes No
*This optional information assists SPR in obtaining grants and awards.
Type of Organization (check one):
College or University For-profit organization
Government agency or organization Private Practice/Consultant
Non-profit research center not affiliated with a university Non-profit service agency
Other  
Occupational Type (check one):
Administrator Practitioner
Educator/Instructor Researcher
Policy Maker  
Current research populations of interest (check all that apply):
Infants Young Children
Elementary Adolescents
Adults Elderly
Current research content areas (check all that apply):
Academic Achievement Neurological Disorders
Addiction Nutrition
Aging Obesity
Alcohol Occupational Safety
Allergies Oral Health
Arthritis Osteporosis
Asthma and Other Respiratory Diseases Other Chronic and Disabling Condition
Cancer Other Health
Cardiovascular Disease Other Infectious Disease
Cognitive Development Physical Activity
Communication Disorders Physical Development
Complementary and Alternative Medicine Physical Health
Crime Poverty and Economic Issues
Delinquency Pregnancy
Dementia Preparedness
Diabetes Public Health
Drug Use Quality of Life
Environmental Health Culture, Race, Ethnicity
Family Violence Sexual Behaviors
Gender Differences Sexually Transmitted Diseases
Genomics Skin Diseases
Health Literacy Sleep Disorders
Healthcare-Associated Infection Social/Emotional Development
HIV/AIDS Stroke
Imaging and Biogengineering Substance Use or Abuse
Infant/Child Health Development Suicide
Injury, unintended Tobacco
Kidney Disorders Unemployment
Maternal Health Vision
Mental Health Women's Health
Minority Health and Health Disparities Youth Violence
Motor Vehicle Accidents Other (specify details in box below)
Research Methods (check all that apply):
Design
Adaptive Intervention Designs Hybrid Designs Combining Effectiveness and Implementation
Adaptive Research Designs Mixed or Multi-Method Designs for Qualitative and Quantitative Studies
Cohort-Sequential (Accelerated Longitudinal) Designs Multiple Baseline Designs Quasi-experimental Designs
Cross-Sectional Designs Regression Discontinuity Designs
Fractional Factorial Designs Sequential Multiple-Assignment Randomized Trials (SMARTs)
Group- or Cluster-Randomized trials Time Series Designs
Analytic - Quantitative
Agent Based Modeling Mediation Analysis
Analysis of High-Dimensional Data Meta-Analysis (of summary statistics)
Analysis of Small Sample Data Methods for Analysis of Intensive or Long Longitudinal Data
Bayesian Methods Microsimulation Methods
Complier Average Casual Effect (CACE) Analysis Missing Data Methods (multiple imputation, full information maximum likelihood)
Casual Inference Mixture Models (including growth and regression mixture models)
Cost-Effectiveness Methods Moderation Analysis
Data Mining Multi-Level or Hierarchical Regression
Decision Analysis N of 1 Experiments
Econometric Methods Network Analysis
General Linear Modeling (including regression, multivariate analysis) Propensity Score Methods
Generalized Linear Modeling (logistic, Poisson, Gamma, etc.) Psychometric Methods
Genome-Wide Statistical Analysis Simulation Methods
Geospatial Analysis Statistical Power Analysis
Growth Modeling Structural Equation Models
Individual Person-Level Meta-Analysis Subgroup Analysis
Integrative Data Analysis Survey Data Analysis
Item Response Theory Survival Analysis
Latent Class and Latent Variable Modeling System Dynamics
Measurement Theory and Methods (EFA, CFA, etc.) Systems Engineering Methods
Analytic - Qualitative
Alternative/Authentic Assessment Document Analysis Focus Groups
Case Studies Key Informant Interviews
Content Analysis Structured Observation
Data Collection and Assessment Methods
Twin and Extended Family Designs
(e.g., children of twins designs, adoption designs)
Machine Learning or Other Artificial Intelligence Methods
Clinical Assessment Methods for Collecting Ecological Momentary Assessment
Computerized Adaptive Testing Neuroendocrine Assessment Cortisol, C-reactive protein)
Electroencephalography (EEG) and Related Methods Neurocognitive Assessment response inhibition, attention
Functional Magnetic Resonance Imaging (fMRI) and Related Quality Control Methods
Genetic Assessment - Candidate genes Questionnaire Development
Genetic Assessment - Genome-Wide Survey Sampling Methods
Genetic Assessment - Sequencing
Areas of Special Interest (check all that apply):
Advocacy Infrastructure
Commercial International
Community Mobilization Training
Current Intervention Targets/Units of Interest (check all that apply):
Individuals Couples
Families Peer Group
Classroom Community Group
Entire Community State
Current Intervention Targets/Ethnicity (check all that apply):
American Indian, Native American Spanish, Hispanic, Latino
Asian, Pacific Islander White, Caucasian
Black, African American Other
Current Research Foci (check all that apply):
Developmental Psychopathology Neuroscience
Dissemination and Implementation Science Other Biological
Epidemiology Other Methodology
Etioloy Prevention Effectiveness
Genetics Preventive Efficacy
Large Scale Implementation
Meta-Analysis
Other (specify details in box below)
Prevention Activities at Your Institution
Is there an endowed chair in prevention at your current institution?
Yes No
Is there a formal training program in prevention at your current institution? (check all that apply)
Undergraduate Graduate
Post-Graduate No Program
Are there courses in prevention science offered at your current institution? (check all that apply)
Undergraduate Graduate
Post-Graduate No Program

Are you a member in other Prevention Science-related organizations?

Yes No (If Yes, please enter below.)

Are you willing to distribute information about SPR to colleagues or students at your institution?

Yes No  

2015 SPR Annual Giving Campaign

Check below if you wish to make an investment in the future of prevention research by contributing to the SPR 2015 Annunal Giving Campaign, which will support such SPR activities as: develop standards of replication, fund minority scholarships, promote science and advance policy.
No, Thanks   $25   $50   $100   Other  $

ECPN John B. Reid Early Career Award Fund

Check below if you wish to contribute to the ECPN John B. Reid Early Career Award Fund.
No, Thanks   $25   $50   $100   Other  $

     

 

Society for Prevention Research's Tax Identification Number is 13-3750819. SPR dues are not deductible as a charitable contribution for federal tax purposes, but may be deductible as a business expense. Contributions are deductible for federal income tax purposes to the extent provided by law. You may submit this form, with credit card payment, online using this secure form. To pay with check or money order, you may CLICK HERE to download a printable PDF version of this form. Print it, fill it out, and mail it to the address at the bottom of this page. You need Adobe's free Acrobat Reader program to open this PDF file.

Society for Prevention Research
11240 Waples Mill Road
Suite 200
Fairfax, VA 22030
P 703-934-4850
F 703-359-7562
Membership@preventionresearch.org