MEMBERSHIP APPLICATION

Please fill out this form and mail it with your dues to: Sue Carlson, Treasurer MALA 4998 Bridgeport Way Norcross, Georgia 30092

2000 DUES - $10.00 Students and retired members $7.00

Name_____________________________________________________________ Title_______________________________________________________________ Institution/Company___________________________________________________ Mailing Address___________________________________________________ City_______________________State_____________Zip__________________ Work Phone_________________ Fax_________________________________ E-mail__________________________________________________________ Home Address (optional)____________________________________________ City______________________State_______________Zip_________________ Home Phone (optional)_____________________________________________ I would prefer that mail from MALA be sent to my home____ work _____ address. I would be interested in working on the following committees: _____ Hospitality _____ Publicity _____ Program _____ Membership _____ Intellectual Freedom _____ Scholarship _____ CAU Mentor Program _____ Other (Please specify) Suggestions for program topics or places of interest to visit: ________________________________________________________________

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