CALA Membership Application Form

Today's Date:

Family Name

First Name | Middle Name

Chinese Name (if any)

Home Address

City

State and Zip Code

Country

Home Telephone

Job Title

Institution

Address

City

State and Zip Code

Work Telephone

FAX/Home FAX

Email Address

[ ] New Member [ ] Renewing Member

Membership Dues cover the full calendar year, from January to December. Dues in U.S. dollar value equivalency or from a U.S. bank.

Please choose one membership category
Individual Member ($30/year)	$
Institutional Member ($100/year)	$
Life Member ($400)	$
Student Member ($15/year)	$
Non-salaried Member ($15/year)	$

Additional Contribution:
CALA General Fund	$
CALA Scholarship Fund	$
CALA Research Fund	$
CALA Books to China Fund	$

Total:	$

Chapters:
[ ] California	[ ] Florida
[ ] Midwest	[ ] Northeast
[ ] Southwest	[ ] Great Mid-Atlantic
[ ] None of the above

CALA Member who recommended you (if any): _________________
I recommend the following potential member:

Name:

Address:

Phone/Email:

Please enclose a check payable to CALA
Send this form and the check to:

Jian Anna Xiong, Chair
CALA Membership Committee
Government Information Librarian
Morris Library
Southern Illinois University-Carbondale
605 Agriculture Drive, Mailcode 6632
Carbondale, IL 62901