MALLMembershipForm2012 2013 by v7166R

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									Membership Form
July 1, 2012 – June 30, 2013
Name __________________________________ Title__________________________________

Institution____________________________________________________________________

Address ______________________________________________________________________

City, State, Zip _________________________________________________________________

E-mail (please provide only 1) ____________________________________________________

Phone # (please provide only 1) __________________________________________________

Type of membership:
 Regular: Employee of law firm ($20)                      Regular: Employee of law school ($20)
 Regular: Employee of government ($20)                    Regular: Employee of vendor ($20)
 Regular: Other ($20)

 Student: 1st year of student status ($0)                 Student: Renewal ($10)
 Unemployed: 1st year of unemployment ($0)                Unemployed: Renewal ($10)
 Retired ($0)

This membership is paid by:               Member          Member’s employer
Are you also an AALL Member?              Yes             No

       Dues                                               $ ______________
       Late Fee ($5.00 if postmarked after July 1st)      $ ______________
       Grant Fund Contribution (Optional)                 $ ______________
       Contributions to the MALL Grant Fund support scholarships and grants, which help MALL support
       professional development.

       TOTAL:                                             $______________

Payment can be made by check or online: http://www.aallnet.org/chapter/mall/2013-online-dues.htm.

Send payment to:        Liz Scheibel
                        Lindquist & Vennum PLLP - Library
                        80 South 8th Street, Suite 4200
                        Minneapolis, MN 55402
                        escheibel@lindquist.com

Make checks payable to MALL. If paying online, email or mail membership form.

PUBLICITY RELEASE: MALL uses event photos and videos for publicity purposes (e.g. in the newsletter,
on the MALL website and in MALL brochures). Check this box if MALL may not use your photo without
your express consent. You may be contacted for permission for specific cases.
        Do not use my picture without consent

								
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