AZLA General Membership Form
Please select one of the options below
I am interested in attending planning meetings or serving on the AZLA Executive Board.
Member Information
First name
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Last name
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Home address
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City
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State
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Zip code
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CONTACT INFORMATION
*Please provide at least ONE telephone number. Type NA for the numbers you do not wish to list*
Cell phone (with area code)
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Home phone (with area code)
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Email(s) - If listing multiple addresses, please separate with a semicolon (;)
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Work and/or Program/Affiliations and Languages
School/Institution/Affiliation (no acronyms)
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Business address
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City
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State
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Zip code
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Work Phone (area code, extension)
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If you work with a school, please select the Type of School
Required
Please select the level(s) you work with
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Please select the program(s) you are affiliated with
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Please select your role
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Please list the LANGUAGE(s) that you teach/direct
Your answer
Please select the organizations below of which you are a member
Required
Do you wish for your information to be included in the AZLA DIRECTORY for exclusive access by other members (upon print or electronic publication in the future)?
AZLA Academic Membership Dues
The AZLA academic year runs from August to September
Please select the appropriate AZLA ACADEMIC MEMBERSHIP DUES below
My total dues are...
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PAYMENT OF FEES
There are 3 payment methods:

1. Check
2. Purchase Order
3. PayPal

How will you pay for your conference fees?
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