Membership Form
Membership year is July 1 through June 30

Complete this form ONLY / AFTER you have paid using PayPal
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Select the appropriate membership category *
Select membership status *
Contact Information
Last Name *
First Name *
Institution *
Street Address *
City *
State *
Zip *
Work Phone
email *
Indicate which committees you would like to serve on
I am interested in hosting an event (meeting or program) at my institution
Clear selection
I am interested in running for a board position
President, Secretary, Treasurer, Member at Large
Clear selection
Clear form
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