To apply for ASSITEJ/USA membership, Please print the following form and mail to:
ASSITEJ/USA
Please make checks payable to: ASSITEJ/USA
P.O. Box 22365
Seattle, WA
98122-0365
For further information, please call: (206)392-2147
Please choose the type of membership from the following choices:
Please fill out all of the remaining information:
ORGANIZATIONAL MEMBERSHIP ___ $100 (Budgets under $250,000) Membership for two
people in organization, one mailing address, included
with this organizational membership.___ $200 (Budgets $250,000 to $999,000) Membership for four
people in organization, one mailing address, included with this
organizational membership.___ $300 (Budgets over $1,000,000) Membership for
six people in organization, one mailing address, included with this
organizational membership.OTHER TYPES OF MEMBERSHIP ___ $50 Individual ___ $25 Student ___ $25 Retiree ___ $65 Individuals and organizations outside the USA ___ $30 Library rate -- non-voting
| MEMBERSHIP INFORMATION | ||
| Renewal | Reinstated | |
| Name(1)_____________________________________________ | ||
| Name(2)_____________________________________________ | ||
| Name(3)_____________________________________________ | ||
| Name(4)_____________________________________________ | ||
| Name(5)_____________________________________________ | ||
| Name(6)_____________________________________________ | ||
| Position/Occupation______________________________________ | ||
| Organization___________________________________________ | ||
| Mailing Address_________________________________________ | ||
| Telephone______________________ Fax_______________________ | ||