2023-2024 Membership Application
Welcome! Are you a student or professional in anatomy or an anatomy-related field? Do you have a passion for anatomy? Do you want to volunteer with Black in Anatomy? Apply for a free membership to Black in Anatomy, Inc.

Black in Anatomy, Inc. is a 501(c)(3) non-profit organization dedicated to creating a safe space to network, uplift, support, and amplify Black contributions to the anatomical sciences (www.blackinanatomy.org).

Members will have access to networking activities, social events, and member-only opportunities.  Most importantly, members can help contribute to and advance the work of Black in Anatomy, Inc. by volunteering with the organization. 

We now have new membership categories to better serve our community. If you filled out a "Join us" form in the past two years from our website, we ask you to complete this membership application and renew your free membership to keep our membership records current. 

Please complete the 2023 membership application form to reaffirm your commitment to the Black in Anatomy community.

If you have any questions, please contact blackinanatomy@gmail.com.

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Full name *
Please provide your full name (first/preferred and last).
Your pronouns *
Please share your pronouns to help us refer to you respectfully. 
(e.g., she/her, he/him, she/they, he/they, they/them, none, or prefer not to say)
Email address  *
Please provide an email that you check frequently.
Professional Affiliation 
*
Please provide your department and university, or organization, employer, business, etc.
Title(s) 
*
(e.g., graduate student, postdoc, resident, research assistant, lecturer, assistant professor, freelancer, medical illustrator, etc.)
Highest Degree Earned
*
(e.g., BS, BSc, BA, MS, MA, MPhil, PhD, MD, etc.; Indicate N/A if you do not hold a degree)
Where do you live? 
*
To help us plan event times, please provide your city, state/province, country.
What do you call yourself? *
(e.g., an anatomist, biological anthropologist, developmental biologist, graphic designer, pathologist, medical student, etc.)
Why do you want to join Black in Anatomy? *
Tell us briefly about your interest in joining Black in Anatomy.
Membership Categories and Interests
Please select your membership category. *
Would you like your name to be listed on our website?  *

In which areas do you want to contribute to Black in Anatomy in 2023?  

*
Please select the areas that most interest you. You may select more than one. 
Required
Professional networks (optional)
If you would like us to follow you on your professional networks and link them on our website, please list them in the spaces below. 
Professional Website
If you have a professional website, what is the URL?
Professional Twitter Handle
If you have a Twitter account where you post about your work, please provide the handle.
Professional Instagram Handle
If you have an Instagram account where you post about your work, please provide the handle.
Do you have additional online professional networks or social media?  
(e.g., LinkedIn, ResearchGate, Academia.edu, Mastodon)
Please list the website and your profile name, if you would like us to follow you and list the link on our website. 
What other additional information, questions, comments, or suggestions do you have? 
Thank you!
If you have questions or need additional information, please contact blackinanatomy@gmail.com

Please add blackinanatomy@gmail.com to your email safe sender list or address book to be sure to receive our emails.

Your application will be processed within a month of submission. Please only fill out the form once. 
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