Northwest Archivists Membership
Application
Dues Year: July 1st – June 30th
_____Individual ($25)
_____New ______ Renewal _____Institutional ($25)
_____Individual
Sponsor ($50)*
_____Individual
Associate ($75)*
NAME
_____________________________________________________________
ADDRESS___________________________________________________________
CITY
__________________________________STATE _______ ZIP ____________
TELEPHONE
(____) _____________ FAX (____)
____________________________
E-MAIL
______________________________________________
INSTITUTION
_______________________________________________________
*Additional
gift supports Scholarship Committee
May we
include your name in a NWA membership directory? ____Yes ____No
(Distributed
to NWA members only)
May we
include your name in a NWA mailing list for distribution? ___Yes ___No
(Name and
address only; may be distributed outside NWA)
When did
you join NWA? ______________
How did you
hear about the NWA? _________________________________________
Please
check the committee(s) on which you are willing to serve:
___Program ___Education ___Nominating
___Scholarship ___Electronic
Access ___Retirement Recognition
___Local Arrangements ___Bylaws
Please
print and fill out this form. Make
checks payable to Northwest Archivists, Inc. and mail to: