MLA Membership Application

Name: ___________________________________________________________
	
Position: _________________________________________________________
	

Please circle: Work or Home

Address: _________________________________________________________
	
  _________________________________________________________________
 
	
City:  _______________________________ State:_______ Zip:__________
	

Phone: __________________________________________________________

Fax:   ___________________________________________________________
	

E-mail: __________________________________________________________
	

Please indicate your library affiliation: 
[  ] Corporate
[  ]  Public
[  ]  Government
[  ] School
[  ] Academic
[  ] Student
[  ] Legal
[  ] Vendor
[  ] Medical
[  ] Trustee/Friend
[  ] Other:___________________________________________________
		




Please select membership level:

$15	Retirees, Students, Unemployed
$20	Salary under $15,000
$35	Individuals (Friends, Trustees)
$35	$15,000 - $24,999
$45	 $25,000 - $34,999
$90	$55,000 - $64,999
$70	$45,000 - $54,999
$60	$35,000 - $44,999
$100	Salary over $65,000

$70	Boards (Friends, Trustees)
$70	Institutional (Non-voting membership)
$150	Sustaining
	  	 

Section Memberships:
[   ]	$0  Paralibrarian Section
[   ]	$5 Technical Services Section
[   ]	$5 Youth Services Section

Total Enclosed: 
  	$ _________	Membership
  	$ _________	Section(s)
  	$ _________	Total

 

Return the completed form to:

            Massachusetts Library Association
            PO Box 1445
            Marstons Mills, MA 02648

 

Regular membership year runs July 1 Ð June 30.  Dues are non-
refundable