MEMBERSHIP FORM
Print this form, fill it out, and mail to the address below
Membership Term:
calendar year 2007
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| Name: | _______________________________________ | ||
| Institution: | _______________________________________ | ||
| Street Address: | _______________________________________ | ||
| City: ____________________ | State: ___________________ | Zip: ___________________ | |
| Phone: Work (_____) _____-_______ |
Home (_____) _____-______ | Fax (_____) _____-_______ | |
| E-Mail Address: | _______________________________________ | ||
|
Interest Areas: Topical Interests: |
Conferences________ Newsletters________ Workshops __________ _______________________________________________________ |
||
| New Member: ______ | Renewal: ______ | ||
|
Individual $25 |
_____ |
Make check payable to: OHMAR |
|
Student $10 |
_____ |
Mail to: |
|
Institutional $75 |
_____ |
OHMAR |
|
Life $1,000 |
_____ |
c/o Constance S. Beninghove |
|
Contribution |
_____ |
642 East Capitol St. NE #1 |
| TOTAL ENCLOSED | _____ |
Washington DC 20003 |