Philadelphia Region
Organization Development Network

 PRODN Membership Application Form 
Memberships extend for one year from the date you join.
(print and complete)
Name: ________________________________________
Title: ________________________________________
Organization: ________________________________________
Business Address: ________________________________________
 ________________________________________
City: ___________________
State:  ____
 Zip: __________
Business Phone: ____________
Fax: ____________
Home Address: ________________________________________
 ________________________________________
   City:  ___________________
State:  ____
Zip:  __________
Home Phone:  ____________
Email Address: ____________________________________
Web Site:  http://_____________________________________

Address for mailings: Home address    Business address
Address for Membership Directory: Home address    Business address
What would you like to gain from your membership with PRODN?
    ________________________________________
    ________________________________________
Membership Type:
     Regular Membership: $100
     Student Membership: $60
Instructions:
   1. Print and complete the form
   2. Mail the form and a check (payable to PRODN)
         

Membership Questions:
Phyllis Jones -- 856-428-7585
membership@prodn.org

PRODN
P.O. Box 2322
Cherry Hill, NJ 08034
215-665-8151
856-216-1493 (fax)

PRODN Info Central:
www.prodn.org

 
PRODN Tax ID#: 23-2875085
Optional Demographic Questions
1. Which of the following OD-related positions best describes your current job? Please check the number that applies to you.
  1. External Independent OD  consultant
  2. External consultant with consulting firm
  3. External Trainer
  4. Internal OD consultant
  5.  Internal Trainer
  6. Internal OD Manager
  7. Work not directly related to OD or HR
  8. HR Generalist
  9. Manager
  10. Student
  11. Professor
  12. Other: _________________________

2. How long have you worked in an OD-related job? Please check the one that applies to you.

  1. 0-3 years
  2. 3+ - 10 years
  3. 10+ - 15 years
  4. 15+ - 25 years
  5. More than 25 years

3. How long have you been a member of PRODN? Pleas check the one that applies to you.
  1. This is my first year.
  2. 1-5 years
  3. 5+ - 10 years
  4. More than 10 years

4. Gender (Please check one)

  1. Male
  2. Female

5. Race (Please check one)

  1. Asian
  2. Black/African ancestry
  3. Hispanic/Latino/Latina
  4. Multiracial
  5. Native Americna/American Indian
  6. White
  7. Other (please specify) ____________________

6. Are you a national OD Network Member?

  1. Yes
  2. No