CSRA Library Association
Application Form 2007

New Membership [ ]
Renewal Membership[ ]

NAME ___________________________________________________________________________

ADDRESS ________________________________________________________________________

CITY/STATE ______________________________________________ ZIP ____________________
______ CHECK IF NEW ADDRESS

HOME PHONE (____)________________________

LIBRARY NAME ___________________________________________________________________

POSITION _________________________________________________________________________

WORK PHONE (____)________________________ FAX PHONE (_____)______________________

EMAIL ADDRESS ____________________________________________________________________

[ ] I do not want my home address and phone number listed in the web membership directory of the CSRA Library Association.

[ ] I am unable to access the CSRA Library Association Newsletter on the Internet. Please mail me a print copy.

The membership year runs from January 1-December 31 . The dues are:

Regular members: $10.00
Student members (currently enrolled): $5.00
Life members (over 50): $150.00
Life members (under 50): $250.00

A portion of the dues will go towards the Elizabeth M. Tyson Memorial Grant (a scholarship fund for library science students at the University of South Carolina).
Please send this form along with a check (payable to the CSRA Library Association) to:

Fay Verburg
Reese Library
Augusta State University
2500 Walton Way
Augusta, GA 30904
(706) 667-4906 / fverburg@aug.edu