Membership Application Form

This form is for credit card applications only.
If paying for your membership by check, you must download and complete the PDF version of the Membership Application Form.

Institutional Discount
APOSW is pleased to offer a 10% discount when 8 or more members of the same Institution join or renew at the same time, submitting their applications together with payment in the form of one check.  Institutions requesting this discount cannot submit their members’ application form online. To receive the  Institution Discount, download the PDF version of the Membership Application Form. Complete a copy for each member and email
to request submission instructions.

Renewing Members
NOTE: If you are RENEWING your APOSW membership, and your member number does NOT appear below, you must first  >> Login here <<
You will then be returned to this form and information from your APOSW member profile will have been pre-entered below.

APOSW Member #:

           (Your Member # must appear at left unless you are applying as a new member.)


In what year did you first join APOSW?


NOTE: All fields labeled in Red are required fields.

First Name:

Middle Initial:

Last Name:

Member Type:



Membership Category:

Regular - $95.00 (BSW, MSW, PhD, DSW)


Associate (non SW professional) - $75.00 (See ASSOCIATE NOTE)

Non-North American - $50.00

Student - $50.00 (See STUDENT NOTE)

Retired - $50.00

2 Year Regular Member (Savings $15) - $175 (BSW, MSW, PhD, DSW)


3 Year Regular Member (Savings $45) - $240 (BSW, MSW, PhD, DSW)



More information regarding membership types


ASSOCIATE NOTE: Associate memberships are open to all non-social worker professionals who shares in the APOSW mission.

STUDENT NOTE: Students must supply proof of status at time of application. Email to

TRANSFERABILITY: APOSW memberships are non-transferable and valid from the submission date of this form through to December 31st, 2017. APOSW Membership must be renewed annually for uninterrupted receipt of member benefits.

CURRENCY: Dues are payable In US Dollars only.


 (e.g. MSW)


Charitable Donation


Donation Type


To help us accomplish our mission by advancing pediatric psychosocial oncology care through clinical social work practice, research, advocacy, education, and program development


Houston Tyler Rothschild Scholarship Fund
Assists APOSW members in attending the annual conference, assuring that social workers are provided up to date information, best practice skills, and resources thereby promoting the careers and skill base of pediatric oncology social workers.


  Other Amount: $ (e.g. 500.00)

  Clear the above selection

  Clear the above selection

Note: Contributions or gifts to APOSW are not deductible as charitable contributions for Federal income tax purposes.
APOSW Tax ID# is 25-1428562

The addresses you enter below will be used for mailing and billing purposes. Please select one from each of the following:

Use this as my Mailing Address: Work Address  | Home/Alternate Address

Use this as my Billing Address: Work Address  | Home/Alternate Address

Work Address


Address 2:



  (Enter 2-character abbreviation only. if US or Canada. E.g. NY)

Zip Code:


   (If you enter this address, you must select a country.)


Home/Alternate Address


Address 2:



  (Enter 2-character abbreviation only. if US or Canada. E.g. NY)

Zip Code:


   (If you enter this address, you must select a country.)


Work Phone:


Home Phone:


Work Fax:


Email Address:

Years in Social Work:

 (Please update each year)

Years in Pediatric Oncology:

 (Please update each year)

Area of specialization:

Please remove me from rented mail list:

(Occasionally, as a revenue generating measure, the membership list is rented out to those who have something to share that we think is of interest or benefit to the membership.)

Become More Involved in APOSW

I am interested in becoming more involved in APOSW:


If so, is there an area that interests you most?:


Briefly describe that area of interest?:

Please Note: As a new APOSW member, an initial password will be auto-generated for you. It will be your last name as it has been entered, above.

At any time you can retrieve your UserID and Password, by clicking the link on the login page
for the members only website to Look-up lost UserID and Password


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