Annual Membership Application

ISLMA offers an annual membership of one calendar year. Your membership, new or renewal, will begin on the date payment is processed and will expire one year from that date. To receive member discounts for workshops, conference registration and other events you must have an active membership. And, to receive Fall Conference discounts you must be a member by the Early Bird registration deadline.

Please make corrections or supply information in the space provided.

Important! This form is for NEW REGISTRATIONS ONLY. If you want to renew your membership, please click here to go to our membership area where you can renew your membership.

Personal Information
*First Name:
*Last Name:
*Address:
 
*City:
*State:
*Zip Code (plus 4): -
*Email:
Alternate Email Address:
*Home Phone:
Cellular Phone:
Fax:
Work Information
Workplace:
Address:
 
City:
State:
Zip Code (plus 4): -
Work Phone:
Other Information
*Third Party Exclusion: Yes No      More information
*Preferred Mailing Address: Home Work
Regional Library System: IHLS (Illinois Heartland Library System)
RAILS (Reaching Across Illinois Library System)
*Type of Membership:

One Year Membership
Personal Membership $65.00
Student Membership $25.00
(Enrolled in a library science program, 5 year limit.)
Retired Membership $40.00
Corporate Membership $85.00

Two Year Membership
Personal Membership $130.00
Student Membership $50.00
(Enrolled in a library science program, 5 year limit.)
Retired Membership $80.00
Corporate Membership $170.00

Disaster Relief Fund Amount: $
Professional Development Grant Fund Amount: $
Scholarship Fund Amount: $
LBSS Endowment Fund Amount: $
Linking for Learning:
(will pick up at Conference)
$15.00 x QTY
Linking for Learning:
(includes S/H and will be mailed)
$20.00 x QTY
Powerful Libraries: the Illinois Study $15.00 x QTY
Total Amount of Payment: $
*Payment Option:
Make checks payable to ISLMA and send with this completed form to ISLMA, P.O. Box 1326, Galesburg, IL 61402-1326.
Online Credit Card Payment
Purchase Order
Check

Credit Card Type:
Name on Card:
Card Number:
Expiration Date: /
CCV:
If you would like to use a Purchase Order, please indicate below:
PO Number:
PO Date:
Full Name of the School District:
Address:
City:
State:
Zip Code:
 
 
If you wish to opt out of the current policy as described in the ISLMA Privacy Policy, you must contact the ISLMA Executive Secretary in writing at either ISLMAexsec@gmail.com or ISLMA, P.O. Box 1326, Galesburg, IL. 61402-1326.
For more information see the ISLMA Privacy Policy.
 

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Online Payments
 

 
     
 
Date Modified: 10/21/16

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Illinois School Library Media Association | PO Box 1326 | Galesburg, IL 61402-1326
Telephone: 309-341-1099 | Fax: 309-341-2070 | email
: ISLMAexsec@gmail.com
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ISLMA is not responsible for the content or availability of any Internet sites external to the ISLMA website.