CSRA Library Association

Application Form 2001/2002

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 name listed in the web membership directory of the CSRA Library Association

[ ] Please mail me a copy of the CSRA Library Association Newsletter - From the Bookshelf

The membership year goes from January 1-December 31 each year. The dues are $7.00 annually, $3.00 of which goes to the Elisabeth M. Tyson Memorial Grant

Please send this form along with a check (payable to the CSRA Library Association) to:

Reese Library
Augusta State University
2500 Walton Way
Augusta, GA 30904

(706) 667-4906