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Please Check
One of the following:
Regular Member: $15.00
Student Member: $7.50
(Graduate and
Undergraduate Students are eligible)
Sponsor Member: Please fill in the amount: $
(Fully
tax-deductible gift of any amount over Regular dues)
Please
Check Here If New Member:
Name__________________________________
Address:
Street and Number __________________________ Apartment
______
City________________
State _________ Zip Code _________
E-mail:
_________________________
Telephone:
______________________
Fax:
___________________________
Institution:
______________________
Department:
_____________________
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