ARLIS/NC - Northern California Chapter
MEMBERSHIP FORM 2008

Name:

Title:
Institution/Library:
Work Address:

Work Phone No:
 Work Fax:

WorkEmail:
Website:
Home Address:
Home Phone No:
Home Fax No:
HomeEmail:
Preferred Mailing Address: ___ Home   ___ Work Preferred e-mail Address: ___ Home   ___ Work


For Students:


Name of School:
Program/Dept.:
____ New Membership  


_____ Renewal  		 _____ Member ($20) 
(For chapter members who belong to ARLIS/NA)

_____ Affiliate   ($20)

_____ Business/Institutional Affiliate ($20)

_____ Student   ($10)
 In addition to my dues, I would Like to
include the following amount:

$_____ Gift to the ARLIS/NA-NC Ann
Gilbert Travel Award Fund

$_____ Unrestricted gift to the Chapter
Make checks payable to: ARLIS/NA-NC and mail to:
Kay Teel, ARLIS-NC Secretary/Treasurer
P.O Box 19490
Stanford, CA 94309-9490		TOTAL ENCLOSED:
$_____