MISSOURI LIBRARY ASSOCIATION

MISSOURI LIBRARY ASSOCIATION

2002 INDIVIDUAL MEMBERSHIP APPLICATION

___New Member ___Renewing Membership is for the calendar year. [Payment by March 1, 2002 assures Directory listing]

MAILING INFORMATION

Name

Title

Library/Company

Preferred Mailing Address City, State, Zip Code

Daytime# Fax# Email MO Senator & dist # MO Rep.& dist #

US Representative & dist Please do not release my mailing address

DIVISIONS

____ACADEMIC LIBRARIES ____PUBLIC ____SPECIAL ____TRUSTEES / FRIENDS

SPECIAL INTEREST GROUPS

___ Children's Services Roundtable ___ Public Relations

___ Computer & Information Technology ___ Reference and Information

___ Government Documents ___ Support Staff / Paraprofessional

___ New Members ___ Technical Services

___ Outreach Services ___ Young Adult Services

___ Professional, Education, Employment, Recruitment

MEMBERSHIP DUES

Salary Range Dues Salary Range Dues Salary Range Dues

__Under $30,000 $30 __40,000-41,999 $41 __54,000-55,999 $55

__30,000-31,999 $31 __42,000-43,999 $43 __56,000-57,999 $57 __32,000-33,999 $33 __44,000-45,999 $45 __58,000-59,999 $59

__34,000-35,999 $35 __46,000-47,999 $47 __60,000-69,999 $65 __36,000-37,999 $37 __48,000-49,999 $49 __70,000-79,999 $75 __38,000-39,999 $39 __50,000-51,999 $51 __80,000-89,999 $85 __52,000-53,999 $53 __90,000+ $95

Citizens, Trustees, Friends __ $30 Students and Retired __ $15 Corporate__$150

Special Memberships: Patron __ $75 Contributing __ $100 Sustaining __ $150

PAYMENT

Membership Dues $_____ Please return form and check to:

Donation to Bohley Scholarship Fund $_____ Missouri Library Association

Amount Enclosed $ 1306 Business 63 South, Suite B

Columbia, MO 65201-8404