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Membership Form
Fill/Print Form
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Please check one:
Membership Renewal _______ |
New
Membership _______ |
Name:
________________________________________________________________ |
Address:_______________________________________________________________ |
______________________________________________________________________ |
City:____________________ |
State:
_________________ |
Zip: __________________ |
I
nstitutional
Affiliation:____________________________________________________ |
Phone Number: _________________ E-Mail
Address: _______________________ |
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Membership Type :
(Please check one) |
| _______ Life Member ($250) |
| _______ Senior / Junior College ($20 / year) |
| _______ K-12 Teacher / Public Historian ($10 /
year) |
| _______ Student ($5 / year) |
| _______ Institutional ($50 / year) |
Please make check payable to the Alabama
Association of Historians and mail with this membership form to:
Alabama Association of Historians
Jeff Gentsch
Station 22
University of West Alabama
Livingston, AL 35470
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