Application and Dues Form

2003-2004
 
 

Name _____________________________________________________

Institution _________________________________________________

Department ________________________________________________

Mailing Address ____________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

e-mail ____________________________________________________

fax _______________________________________________________

URL _____________________________________________________

 

FACULTY: $20.00 

STUDENT: $10.00 

Position/Title _____ Degree Sought_______ Expected Date _____

INSTITUTIONAL:

Regular: $40.00 

Supporting: $200.00 + 

Sustaining: $500.00 + 

PLEASE RETURN THIS FORM WITH YOUR
PAYMENT IN US$ TO:

Erika H. Gilson, Executive Secretary-Treasurer
3 Hawthorne Drive, Cherry Hill, NJ 08003-2221

THANK YOU!

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