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ACRL Diversity Alliance INVOICE
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REMIT TO:ACRL Diversity Alliance Attn: Allison Payne50 E. Huron St. Chicago, IL 60611Fax: (312) 280-2520 Email: [email protected] Telephone: (312) 280-2519
Description AmountACRL Diversity Alliance Annual Fee
$500.00
Total $500.00
QUESTIONS? Please contact Allison Payne at [email protected] or call (312) 280-2519. Thank you!
FOR OFFICE USE: Received:
Processed by:
Process date:
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Notes:
CONTACT INFORMATION: Institution/Company:
Residency Coordinator Name:
Residency Coordinator Title:
Street Address:
City, State, Zip:
Phone:
E-mail Address:
E-mail Address for Diversity Alliance Digital Badge (if different from above):
TERMS Please remit this completed form with payment information or check within 30 days. Confirmation of payment will be sent to you upon receipt. ACRL FED ID# 36-2166947
PAYMENT METHOD: __ Enclosed check payable to, “American Library Association”
__ Visa __ MasterCard __ Amex
Credit Card number:
Name on card:
Expiration date: CVV:
Date: Invoice #:
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