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Membership Form
Membership year is July 1 through June 30
Complete this form ONLY / AFTER you have paid using PayPal
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* Required
Select the appropriate membership category
*
Individual/Professional Membership = $15
Student/Retiree Membership = $10
Select membership status
*
New Member
Returning Member
Contact Information
Last Name
*
Your answer
First Name
*
Your answer
Title
Your answer
Library
Your answer
Institution
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Choose
Maryland
Pennsylvania
West Virginia
Zip
*
Your answer
Work Phone
Your answer
email
*
Your answer
Indicate which committees you would like to serve on
Communications: Newsletter
Communications: Web
Nominations
Professional Development
Program
Membership
I am interested in hosting an event (meeting or program) at my institution
yes
no
Clear selection
I am interested in running for a board position
President, Secretary, Treasurer, Member at Large
yes
no
Clear selection
Submit
Clear form
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