SOCIETY OF AMERICA, INC.
Application for Membership/Renewal
Please fill out completely in consideration for membership or renewal.
New _____ Renewal _____
______ Active Membership [Available to those who currently own or have owned and cared for nonhuman primates at the discretion of the Board.] (“Caring” shall be defined as providing housing on your premises, SIMIAN feeding, maintenance, and veterinary care of captive non-human primates.)
______ Associate Membership [Available to those who do not currently own and care for a nonhuman primate at their
premises but have an interest in nonhuman primates and wish to support the organization and its purposes and objectives at the discretion of the Board.]
CLASSES OF MEMBERSHIP
Individual Membership: $40.00
Spouse: (Same address/no publication.) May be purchased only in conjunction with an individual active membership: $10.00 (Husband, wife or life-partner ONLY)
Life Membership* (active membership only) $750.00
(*Life memberships may not be transferred to another person and are non-refundable.)
Membership is renewed each July. New members joining January – June, pay for a full year PLUS the prorated amount of the remainder of the year.
OUTSIDE USA: Please add $25.00 Canadian, $45.00 foreign mailing. Dues must be in USA currency. Allow four to six weeks for first delivery.
All dues and foreign postage are prorated to renew each July.
* Applicants meeting one of these criteria may be issued an active membership at the discretion of the Board.
Memberships will be reviewed each year.
Additional donations may be made to the following funds:
PHN (Primate Health Network) $__________ LHPP (Lu Hall Primate Placement) $__________________
Legislation $_________ General Fund $______________ Education Department $___________________
Publications $____________________ In Honor or Memory of $______ Name _____________________
PLEASE PRINT CLEARLY. All information you provide will remain confidential.
NAME ___________________________________SPOUSE _____________________________________
CITY _____________________________________________ STATE __________ ZIP ________________
PHONE (H) __________________________________ (W) _________________(C) __________________
FAX (H) __________________________________________ (W) __________________________________
EMAIL ADDRESS ________________________________________________________________________
Are you a member of an SSA Chapter?
Designated Home Chapter __________________ Member of other Chapters, which ones? ____________
References of current SSA Members (2)
Name: ________________________________ Name _________________________________________
Email: ________________________________ Email: _________________________________________
Phone: ________________________________ Phone: _________________________________________
The questions below are required to be answered in consideration of membership:
providing housing on your premises, feeding, maintenance, and veterinary care of
captive non-human primates.) Yes No
Please list below primates in your care (species, name, age, sex, year of birth, or DOB if known
Please list the Veterinarian, including full address, phone number and email address that cares for your primates.
Are you involved in or a member of, or affiliated with any individual, group or organization that is working to create bans of private ownership of nonhuman primates? Yes No
If yes, please explain in detail. If not enough room please write on addition paper.
I declare that I have reviewed all information on this application and have answered all questions truthfully and correctly. I understand that the SSA reserves the right to refuse or revoke my membership at any time according to the bylaws. I have read and agree to the terms of membership.
Signed: ________________________________________________ Date: ___________________________
Enclosed please find my check in the amount of $ ______________, payable to the Simian Society of America; Inc. Membership may be paid through PayPal. If using PayPal, there is a $2 processing fee. Your Application or Renewal MUST be emailed or sent to the Membership Chairman with the PayPal proof of payment for your membership to be renewed.
PayPal email is:
Mail application & payment to
1624 Windsong Forest Road
Clover, SC. 29710