NCJLT Individual or Corporate Membership Form

NCJLT Individual or Corporate Membership Form

Date: Day_____ Mo______ Year________

Membership:___ New ____ Renew for year: ________________

Name: ________________________________

Institution Name: ________________________________

Mailing Address: ________________________________

Phone (H=Home, S=School) H: _______________________ S:________________________

Fax:_______________________ e-mail:_______________________

_____ Check if you prefer to receive Oshirase by e-mail

PLEASE NOTE:
Newsletters will be sent to your mailing address.
Any memberships received after January of a given year will only be good until December of that year.

*If you are a member of one of the affiliates listed on the homepage (http://www.ncjlt.org/) you may already have joined NCJLT as part of your membership fee to your affiliate.

_____$20 Individual member
_____$25 International Individual Member
_____$35 Domestic Institutional Membership*
_____$40 International Institutional Membership*
_____$95 Corporate Membership**

* Institutional memberships include Oshirase but do not include ACTFL attendance benefits.
**Corporate membership includes Oshirase as well as 2 persons receiving ACTFL attendance benefits.

Payment is by December 15 to receive all the benefits of membership, which include: One full year of Oshirase (4 issues) and participation at the ACTFL Conference as an NCJLT member.
Please send this form, with your check made out to "NCJLT" to:

NCJLT
P.O. Box 3719
Boulder, CO 80307-3719