2009
M/MLA DEPARTMENTAL MEMBERSHIP FORM
(January 1st to December 31st)

IMPORTANT: Please be sure to PRINT CLEARLY and provide ALL of the requested information. If your institution has multiple campuses, please include the campus.

Department ___________________________________ Building _____________________________

Institution _____________________________ Street ______________________________________

City, State, Zip ________________________________________ E-Mail ______________________

Department Executive Officer _________________________________ Phone __________________

 

Dues:
(Circle One)

One year: $40

Two years: $70

Three years: $100

 

Mail this form, along with payment (a check or money order in U.S. funds), to Midwest Modern Language Association, Department of English, Loyola University Chicago, 6525 North Sheridan Road, Chicago, IL 60626.

Rec'd _______ Amt $ _______ Check # _______ D’base _______ Acknowl _______ Dep _______