Complete This Form to Become a HUSITA Member

Please enter an username and password.

*Username	(6 - 15 characters)
*Password	(6 - 15 characters)
*Confirm Password

Please provide the following contact information:

*First Name
*Last Name
Middle Initial
Position
Organization
*Primary city of residence
*State or Province
*Country of residence, e.g., USA, China
*E-mail
URL

Enter up to 5 of your interests concerning human services information technology.  Interest does not imply that you have expertise in the areas listed.  If possible, use keywords that will aid in searching the database.

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Enter up to 5 areas in which you have expertise.  Expertise implies that you have some research and development experience or are knowledgeable of the literature in an area.  If possible, use keywords that will aid in searching the database.

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Select your willingness to help by clicking one or more of the following checkboxes..

Consult on projects
Be a member of a research/dissertation committee
Volunteer to help on HUSITA activities, e.g., maintain a subweb site, serve on a virtual committee
Help with the HUSITA conference

Indicate up to 3 topics that you feel need to be researched.  This is useful for theses/dissertations/grants

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Please provide a short biographical sketch or a link to your biographical information.

Provide up to 5 links to your writings, research, and applications, etc., followed by keywords that describe the link. If possible, use familiar keywords that will aid searching the database.

URL link to your writings/research/application	Keywords describing writings/research/application