Art Libraries Society of North America | Mountain West Chapter
2009 Membership Application Form
Name
Title
Organization/Department
Institution
Address
City, State, Zip Code
Business Phone/ Fax
E-mail
Mail should be sent to: ____ Home ____ Business
Home Address
City, State, Zip Code
E-mail/Phone
Membership Dues

All Categories $15.00 per year (January-December)
___ Individual Member (must also be a member of ARLIS/NA)
___ Individual Affiliate (non-voting)
___ Institutional
___ Business Affiliate
___ Student Member (must also be a member of ARLIS/NA)
___ Student Affiliate (non-voting)
___ Retire

TOTAL____________

Travel Award Fund
To help fund the Winberta Yao Travel Award, please add donation of:
___ $10.00
___ $15.00
___ $20.00
___ $25.00
___ other amount

TOTAL ____________

TOTAL SUBMITTED

_________________
To join or renew membership, print out this form and send it with a check payable to ARLIS/NA-MW to:
Peggy Keeran, ARLIS/NA-MW Secretary/Treasurer
Penrose Library
University of Denver
2150 E. Evans Avenue
Denver, CO   80208