I have placed a star * next to my preferred mailing address. WORK ADDRESS: (Please type or print legibly) Voice: (____)_________ Ext. _______ FAX: (____)_________ E-mail: HOME ADDRESS: (Please type or print legibly) Home phone: (____)_________ ALA Membership Number: Are you now a member of LIRT? Yes ____ No ____ Signature: ______________________________________ Date: _____________ Print or Type Name: ______________________________________ Please RETURN A COPY TO THE CURRENT Vice-President. Please keep a copy for your files.
I have placed a star * next to my preferred mailing address. WORK ADDRESS: (Please type or print legibly) Voice: (____)_________ Ext. _______ FAX: (____)_________ E-mail: HOME ADDRESS: (Please type or print legibly) Home phone: (____)_________ ALA Membership Number: Are you now a member of LIRT? Yes ____ No ____ Signature: ______________________________________ Date: _____________ Print or Type Name: ______________________________________ Please RETURN A COPY TO THE CURRENT Vice-President. Please keep a copy for your files.