Indiana Black Librarians Network Annual Membership Application

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Mission Statement:
We provide an opportunity for black librarians to exchange and share ideas, collaborate on library-related projects, promote professional development activities, sponsor scholarship initiatives, serve as a network for the sharing of information between librarians and para-professionals throughout the State of Indiana, and to establish channels of communication between black librarians and para-professionals statewide.

Membership Runs from July 1st - June 30th

Email *

Membership Type *

New Membership

Renewal

Name and Preferred Mailing Address (city, state and Zip code) *

Library or Institution

Full Business Address

Contact Phone Number

Personal Email

Business Email

Members are automatically subscribed to IBLN electronic discussion form; please indicate your preferred email for this subscription. *

Personal

Business

Section 2: Membership Type and Payment Details

Type of Library *

If Other please specify

Membership Type *

$20 - Librarian

$10 - Support Staff (Clerical/Paraprofessional)

$5 - Student

$20 - Other membership

If Other please specify

Scholarship Fund Donation?

Section 3: Member Information

Please indicate if you would be willing to serve on a chapter committee?

Yes

Not at this time

Clear selection

Is there a specific committee you would like to serve on?

Membership Committee

Programming Committee

Nominating & Elections Committee

Permission to use photographic images: Photographs of IBLN members may be used in various IBLN communications including the newsletter and website. Group photographs taken at IBLN events may be used without identifying and notifying individual members. For individual photographs, please indicate your permission for use: *

IBLN has my permission to use and identify photographs of me.

IBLN does not have permission to use and identify photographs of me.

IBLN must contact me before using any identified photographs of me in IBLN communications.

Please make checks payable to Indiana Black Librarians Network, and include "IBLN Membership Fees" on the memo line.

For Payments via Paypal: INBlackNet@gmail.com

Please mail checks to the IBLN Treasurer:

Stephen Lane II

755 W. Michigan Ave

Indianapolis IN, 46202

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