JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
BCALA-Connecticut Affiliate Membership
Black Caucus of the American Library Association - Connecticut Affiliate
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Membership type
*
New
Renewal
Institutional /Organization
Full Name
*
Your answer
Date
*
MM
/
DD
/
YYYY
Preferred Mailing Address (please include city, state and zipcode)
*
Your answer
Employer / Institution Name
*
Your answer
Job Title
*
Your answer
Phone Number
*
I can be reached on my work extension
I can be reached on my cell phone
Required
Email Address
*
Work (email preferred)
Personal (email preferred)
Membership Type
*
Library Employee- $20.00 per year
MLIS/MLS Student -$4.00 per year
Library Ph.D Student- $10.00 per year
Library Organization- $100.00 per year
Non-Library Organization- $150.00 per year
Friend of the BCALA-CT- $35.00 per year
Note: We encourage our members to also consider joining the BCALA National organization. For more information go to
www.bcala.org
Required
Library Affiliation
*
Academic
Government
Public
School
Board/ Trustee
Special
Retired
Publishing
Library Student
Required
I'm interested in joining this committee....
Program Committee
Membership Committee
Scholarship Committee
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
