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ALABAMA TWO-YEAR COLLEGE LIBRARY ASSOCIATION

Membership Form

(Please Print)

Name: __________________________________________ Date: ____________________

Title/Position: _________________________________________________________________

Home Address: ________________________________________________________________

City: ______________________________ State: _____________ Zip: ______________

Phone: (____)_____-_________ Work: (____)_____-________ Fax: (____)_____-_______

E-Mail Address: _______________________________________________________________

Institution: ____________________________________________________________________

Address: _____________________________________________________________________

City: ______________________________ State: _____________ Zip: ______________

I would like to volunteer for the following committee:

_____ Membership _____ Nominating _____ Awards

_____ Publicity _____ Legislative

Comments: ___________________________________________________________________

_____________________________________________________________________________

Membership Dues: $10.00 Institutional Membership Dues: $25.00

_____ New _____ Renewal

Return To: Susie Elliott Make checks payable to:

Bevill State Community College Alabama Two-Year College

1411 Indiana Ave. Library Association

Jasper, AL 35501

For Office Use Only:

Date: __________ Total Paid: __________ Membership Number: __________

Membership Expires: __________

Payment Method: _____ Check _____ Cash

al2yclib