Contact Webmaster jhaley@bsu.edu  *  Last updated 5/23/2008

Original website design 11/01/2006 by Jennifer Haley

 

 

membership application

Last Name:          First Name:

Middle Initial:     Institution:

Street Address (line 1):    (line 2)

City:     State: Zip:

Daytime Phone: (Enter xxx-xxx-xxxx with no parenthesis)

Evening Phone:   E-Mail Address: 

Fax Number:    Membership Type: 

Renewal or New Member? Have you earned LCLC?

Are you interested in serving on a committee

Payment Option (please check one):

I will send payment through the mail:

I will pay through PayPal (PayPal button is on the Membership page):

The Membership Secretary Tammy Pratt will contact you within one week of receiving and applications AND dues payment.

You must click "Submit" to submit this application.