2025 ASIS&T Distinguished Member Application

The application will save every time you click the "Next" button so if you need to leave the survey and return to it later you may do so.
1.First Name(Required.)
2.Last Name(Required.)
3.Email(Required.)
4.Telephone(Required.)
ASIS&T Service History
5.Please indicate in which of these roles you have served. ASIS&T staff will confirm this in your membership record.
6.Please indicate the year(s) in which you served in these roles: