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:
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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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