Membershiponline

Full Name(Required)

First Name Last Name

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Email(Required)

Phone Number(Required)

Twitter Handle

District Name

School Building Name

School Address

Street Address City State / Province / Region ZIP / Postal Code

School Phone

Choose Membership

One Year – Personal Membership – $65.00

One Year – Student Membership (Enrolled in a library science program, 5 year limit.) – $25.00

One Year – Retired Membership – $40.00

One Year – Corporate Membership (Public libraries, companies and agencies) – $80.00

Two Year – Personal Membership – $130.00

Two Year – Student Membership (Enrolled in a library science program, 5 year limit.) – $50.00

Two Year – Retired Membership – $80.00

Two Year – Corporate Membership (Public libraries, companies and agencies) – $170.00

Choose Payment Options(Required)

Online Credit Card Payment

Personal Check

Purchase Order

PO #(Required)

School District Name(Required)

District Business Office Address(Required)

Street Address City State ZIP Code

Accounts Payable Email Address(Required)

Comments

Credit Card(Required)

Please fill out your credit card information below if you selected the “Online Credit Card Payment” option above.

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Membership online