Please check one:

Renewal New Life Member

Date:__________________
Mr. Mrs. Ms. Dr.  Other______ Principal area of work:
Last name: First name:
Administration
Adult Services
Home address: Archives/Preservation
MEMBERSHIP APPLICATION 2011

Bookseller/Vendor
City, State, Country: Zip (or Postal) Code: Cataloging & Classification
Children’s Services
Collection Development
Home phone# Email:
Consultant
Business name & address (students include school name & address): Digital Library Services
Inst’l Services
Address 1:
IT/Web Services
Address 2: Library School Student
Library School Faculty
City, State, Country: Zip (or Postal) Code:
Literacy Marketing/Outreach
Business phone# Email: Multilingual Services
Public Services
Which is your preferred address for Readers Advisory
 Home  Business
REFORMA mailings? Reference Services Retired
Special Collections
 Yes No Technical Services
Would like to be added to third party
mailing lists?
If yes, which address? Teen/YA Services
Home Business  Both Other

Preferred email address:  Home  Business

Level of Membership (please check one)
Personal Membership Institutional Membership
 Librarian earning >$59k / year $40.00  Library / Library School $50.00
 Librarian earning $30-59k / year $30.00  Corporation $200.00
 Librarian earning < $30k / year $25.00  Non Profit Organization $50.00
 Library support staff $15.00
 Library trustee / commissioner $20.00 NO CASH PLEASE

 Library Science student (1st Year) Waived Check or money order (payable to REFORMA)

 Library Science student (2nd Year) $5.00 for MEMBERSHIP DUES: $________________

 Life Membership $400.00 Check or money order (payable to REFORMA SCHOLARSHIP

 International Member Waived FUND) for SCHOLARSHIP DONATION: $________________
 Community Supporter / Retiree $15.00
All membership periods will expire one year from your join/renew date. Join/Renew online at: http://www.reforma.org/

Chapter Affiliation (Chapter and At-Large members are automatically national members)
Check one:  I choose to be a Member-At-Large (no chapter affiliation)  I choose to be affiliated to the chapter below (choose one)
 Bibliotecas para la Gente (Bay Area, CA)  Estrella de Tejas (San Antonio, TX)  Northwest (WA, OR)
 California Gold (Greater Sacramento Area, CA)  Heartland (MO KS, MN, NE)  Orange County (CA)
 Central Arizona  Libros (San Diego, CA)  Puerto Rico
 Colorado  Los Angeles  Rio Trinidad (Dallas / Ft. Worth, TX)
 Corazón de Tejas (Austin, TX)  Midwest (IL, IN, WI)  Southeast (AL, GA, KY, MS, TN, VA)
 El Paso  Northeast (PA, NJ, NY, CT, RI, MA)  Tucson
For information on REFORMA, its chapters, or its committees, please visit: http://www.reforma.org
I’m interested in these REFORMA Committees, etc. (check as many as desired):
 Children & YA  Newsletter  Recruitment & Mentoring  Public Relations
 Education  Legislative  Mora Award  Belpré Award
 Fundraising  Trejo Lib of the Year  Translations  Review Editor
 Information Technology  Membership  Program  Scholarship
 International Relations

REFORMA National Office

c/o Sandra Ríos Balderrama
Mail application and payments to:
PO BOX 4386
Fresno, CA 93744