Membership Application 2008

Membership dues are due the first of each year

êMr. êMrs. êMs. êDr. Date: Last Name: First Name: MI:
Home Address:______________________________________ Home E-mail address:_____________________________ City: State: Zip: Phone number: Business Address:_____________________________________ Business E-mail address:_____________________________ City: State: Zip: Phone number: Which address do you prefer to receive REFORMA mailings? Please check one: êHOME êOFFICE Do you want to be added to mailing lists that can be shared with others? êYES êNO
Type of Library: êPublic êAcademic êSpecial êSchool êOther (please note):
Institution or Library Name:
Title: êAdministrator êFaculty/Lecturer êStudent êDepartment Head êLibrarian êSupport Staff êOther:
Would you like to be added to the REFORMANET listserv? êYes êNo Preferred E-mail address: ê Home ê Work Would you like to be added to the directory on the website? êYes êNo Preferred E-mail address: ê Home ê Work
Personal Membership êLibrarian earning >$60K/yr............................................. $40.00 êLibrarian earning $30K - $59K/yr................................... $30.00 êLibrarian earning <$29K/yr............................................. $25.00 êLibrary support staff....................................................... $15.00 êLibrary Trustee/Commissioner........................................ $20.00 êLibrary Science Student (waived for first year)................. $5.00 êLife Member………………………………………………….$400.00 êInternational Personal Member....................................... $10.00 êCommunity Supporter/Retiree......................................... $15.00		National Membership êLibrary/Library School.............................................. $50.00 êCorporation ..................................................... $200.00 êNon-profit Organization........................................... $50.00 ______________________________________ Membership dues .................................................. $ Scholarship Fund Contribution...................................... $ Total Enclosed $ Payment by: êCheck #__________ êMoney Order
Check one: I choose to belong to: êMember At Large (no chapter affiliation) rChapter (choose only one from below) Note: Chapter Members and Members-At-Large are automatically National REFORMA members
¡Arriba! (SE Texas) Bibliotecas Para La Gente (N. California) Carolina Chapter Central Arizona Chapter Colorado Chapter Corazón de Tejas (Austin, TX) DC Metro Chapter (DC, MD, VA) El Paso (TX) Florida Chapter	Heartland (KS, MO, NE, MN) Inland Northwest (WA, OR, ID) Libros (San Diego, CA) Los Angeles Chapter Midwest Chapter (IL, IN, WI) Minnesota Chapter Nevada Chapter r REFORMA de Nuevo México Northeast (NY, NJ, PA, CT, RI, MA)		Orange County (CA) Pacific Northwest (WA, OR) Puerto Rico Chapter Rio Trinidad (Dallas, TX) San Antonio (TX) Tarrant County (TX) Tucson (AZ) Utah Chapter
Special Interests or Skills that you are willing to share with other Reformistas:
National REFORMA Committee Interest (check all that apply)
êChildren’s & Young Adult Services êEducation êFundraising êInformation Technology êInternational Relations	êLegislative êTrejo Librarian of the Year êMembership êMentoring êRaul & Estela Mora Award êNewsletter		êProgram êPublic Relations êPura Belpré Award êReview Editor êScholarship êTranslations
Mail application to: Dexter Katzman Make checks payable to: Sunland Park Community Library REFORMA 984 McNutt Road Sunland Park, NM 88063-9039