SSS Member Demographic Data Form

Directions: Please fill in the blanks/check the appropriate box.
When you are finished, please click on the "Submit" button at the bottom of the page.

First Name:
Last Name:
Email:
University / Affiliation:
Gender
(Check One)

Male
Female
Do not record

Race
(Check All
That Apply)
White
Black or African American
American Indian and Alaskan Native
Asian
Native Hawaiian and Pacific Islander
Some Other Race
Do not record
Are you Latino or Hispanic?
Yes
No
Do not record
Affiliation
(Check One)
Academic-Two Year College
Academic-Four Year College
Academic-University
Government-Federal
Government-State or Local
Private Industry-Profit
Private Industry-Non Profit
Other- Self Employed
Retired
Other
Do not record
May we share your address with SSS Affiliated Organizations?
Yes, Share my address.
No, Do not share my address.
I would be interested in being a reviewer for Social Forces?
Yes
No
I would be interested in serving on an SSS committee
Yes
No
Areas of Sociological Interest:
Please select one interest from each pull down menu, in order of priority.

First:

Second:

Third:

Fourth:

Area(s) of Specialization (example: Weberian Thought)