MEMBERSHIP & MEMBERSHIP RENEWAL APPLICATION

Please fill out this form and mail it with your dues to:

Name_____________________________________________________________

Title_______________________________________________________________

Institution/Company_________________________________________________

Preferred Mailing Address____________________________________________

City _______________________State_____________Zip__________________

Work Phone_________________ Fax_________________________________

E-mail__________________________________________________________



I would be interested in working on the following areas:

_____ Hospitality             _____ Publicity          _____ Program 

           _____ Membership          _____ Intellectual Freedom          _____ Scholarship

     _____ Other (Please specify)

____________________________________

Suggestions for program topics or places of interest to visit:

________________________________________________________________

________________________________________________________________