NY-NJ Chapter of MLA -- Membership Form

NY-NJ CHAPTER of MLA MEMBERSHIP FORM

Please make checks payable to: NY-NJ CHAPTER OF MLA. Dues are $15 per calendar year.
Print and mail the form to the address below.
Electronic submission of the form is for PayPal users only.

TYPE OF MEMBERSHIP (required)

New	Renewal
Student	Retired

NOTE: Information provided below will be published in the Chapter Directory. Please be as complete and as legible as possible.

Name:

Job Title:

Institution:

Library:

Address:

City:

State: Zip:

Telephone:

Fax:

Email address:

NOTE: Your email address will automatically be added to the Chapter listserv. If you do not wish to be added to the Chapter listserv, check here:
Please note that by opting out, you are abrogating your right to participate in Chapter business (announcement of slate, distribution of the Directory, announcements of CE and Newsletter publication) which will be conducted on the listserv.

Are you a personal member of the national MLA? (Do not answer "yes" if you are an institutional member only.)

Yes
No

Please print and mail in the form along with your payment to:

Marie Ascher
New York Medical College
Health Sciences Library
Basic Sciences Bldg.
95 Grasslands Road
Valhalla, NY 10595

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