MAC Membership Renewal Form 2021 - MemberClicks
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Annual Dues Renewal Form 2021 Username: _______________________________ Prefix: _______________________________ Pronouns: ___________________________________________ Full Name: ________________________________________________________________________________________ If your username and name are provided - please do not complete the section immediately below. To update your membership information or to obtain your username, please log in at http://www.midwestarchives.org/login and choose “View Membership Profile.” For assistance, contact [email protected]. Title: ________________________________________________________________________________________ Institution: ________________________________________________________________________________________ Department: ________________________________________________________________________________________ Address: ________________________________________________________________________________________ City: _______________________________ State: ________ Zip Code: _____________________________ Phone: _______________________________ Mobile: _____________________________________________ Email: _______________________________ Secondary Email: _____________________________________ Mailing Address (if different from above) Address: ________________________________________________________________________________________ City: _______________________________ State: ________ Zip Code: _____________________________ DUES AMOUNT: Dues Enclosed: $___________ $55 USD – Individual $100 USD – Institutional $110 USD – Institutional Canada/Mexico $120 USD – Institutional International $20 USD – Full-Time Student (Include copy of student ID) TOTAL ENCLOSED: $___________ Annual membership is based on a calendar year, January 1st through December 31st. Forms received between October 1st and December 31st will be applied to the next calendar year. To join, please make your check payable to “Midwest Archives Conference” and mail this completed form with payment to: Midwest Archives Conference 2598 E. Sunrise Boulevard, Suite 2104 Fort Lauderdale, FL 33304 USA Midwest Archives Conference (MAC), a not-for-profit organization, welcomes contributions and gifts for the scholarship funds or to offset operating expenses. A contribution in addition to your dues would be appreciated. Please photocopy this form for your records; receipts are available only upon request. Optional donations may be deductible under Sect. 170 of the IRS code. Please consult your tax advisor. For more information about MAC, including the latest news, conferences and member benefits – please visit www.midwestarchives.org. Student Meeting Registration Scholarship Fund: $___________ Mark A. Greene Fund: $___________ Emeritus Scholarship Fund: $___________ General/Operating Fund: $___________ Optional Donations In our continued efforts to be more financially and environmentally sustainable, MAC is now asking members to consider electronic-only delivery of MAC publications. If you choose e-delivery, you will receive an expanded email when the new publication is available on the MAC website. Print Online Only Preference for delivery of MAC Newsletter (CHOOSE ONE) o o Preference for delivery of Archival Issues (CHOOSE ONE) o o For budgeting reasons, your choice can be modified only during the next renewal period.
Transcript of MAC Membership Renewal Form 2021 - MemberClicks
Annual Dues Renewal Form 2021
Username: _______________________________ Prefix: _______________________________ Pronouns: ___________________________________________ Full Name: ________________________________________________________________________________________ If your username and name are provided - please do not complete the section immediately below. To update your membership information or to obtain your username, please log in at http://www.midwestarchives.org/login and choose “View Membership Profile.” For assistance, contact [email protected]. Title: ________________________________________________________________________________________ Institution: ________________________________________________________________________________________ Department: ________________________________________________________________________________________ Address: ________________________________________________________________________________________ City: _______________________________ State: ________ Zip Code: _____________________________ Phone: _______________________________ Mobile: _____________________________________________ Email: _______________________________ Secondary Email: _____________________________________ Mailing Address (if different from above) Address: ________________________________________________________________________________________ City: _______________________________ State: ________ Zip Code: _____________________________ DUES AMOUNT: Dues Enclosed: $___________
$55 USD – Individual
$100 USD – Institutional
$110 USD – Institutional Canada/Mexico
$120 USD – Institutional International
$20 USD – Full-Time Student (Include copy of student ID)
TOTAL ENCLOSED: $___________
Annual membership is based on a calendar year, January 1st through December 31st. Forms received between October 1st and December 31st will be applied to the next calendar year. To join, please make your check payable to “Midwest Archives Conference” and mail this completed form with payment to:
Midwest Archives Conference
2598 E. Sunrise Boulevard, Suite 2104 Fort Lauderdale, FL 33304 USA
Midwest Archives Conference (MAC), a not-for-profit organization, welcomes contributions and gifts for the scholarship funds or to offset operating expenses. A contribution in addition to your dues would be appreciated. Please photocopy this form for your records; receipts are available only upon request. Optional donations may be deductible under Sect. 170 of the IRS code. Please consult your tax advisor. For more information about MAC, including the latest news, conferences and member benefits – please visit www.midwestarchives.org.
Student Meeting Registration Scholarship Fund: $___________ Mark A. Greene Fund: $___________ Emeritus Scholarship Fund: $___________ General/Operating Fund: $___________
Optional Donations
In our continued efforts to be more financially and environmentally sustainable, MAC is now asking members to consider electronic-only delivery of MAC publications. If you choose e-delivery, you will receive an expanded email when the new publication is available on the MAC website.
Print Online Only
Preference for delivery of MAC Newsletter (CHOOSE ONE) o o Preference for delivery of Archival Issues (CHOOSE ONE) o o For budgeting reasons, your choice can be modified only during the next renewal period.
