FACULTY MEMBER REGISTRATION FORM
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Faculty Member Registration Form

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We are a two-year institution and would like an AH&LA Faculty membership for $250 (this includes three contacts from our institution). We are a four-year institution and would like an AH&LA Faculty membership for $450 (this includes five contacts from our institution).
Primary Contact Information

School Name:
First Name:	Mr. Mrs. Ms.
Last Name:
Title:
Address:
City:
State:	ALABAMA ALASKA AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT D.C. D.O.D. CARIBBEAN D.O.D. EUROPE D.O.D. PACIFIC DELAWARE FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARIPOSA MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NONE NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SAIPAN SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
Zip:
Country:	AFGHANISTAN ALGERIA ANDORRA ANGOLA ANGUILLA ANTIGUA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBIJAN BAHAMAS BAHRAIN BANGLEDESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOTSWANA BRAZIL BRITISH GUIANA BRUNEI BULGARIA BURKIMA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECHOSLOVAKIA DENMARK DJIBOUTI DOMINICA - BVI DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR ENGLAND EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE FRENCH ANTILLES FRENCH POLYNESIA FRENCH WEST INDIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GRENADA GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY IVORY COAST JAMAICA JAPAN JORDAN KASAKHSTAN KENYA KINDOM OF LESOTHO KOREA KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTE CARLO MOROCCO MOZAMBIQUE MYANNAR NAMIBIA NEPAL NETHERLAND ANTILLES NETHERLANDS NEVIS NEW CALEDONIA NEW GUINEA NEW HEBRIDES NEW ZEALAND NICARAGUA NIGER NIGERIA NORTHERN IRELAND NORWAY OMAN PAKISTAN PANAMA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL PUERTO RICO QATAR REPUBLIC OF NAURU REPUBLIC OF VANUATU REUNION ROMANIA RUSSIA RWANDA SAO TOME & PRINCIPE SAUDI ARABIA SCOTLAND SENEGAL SEYCHELLES SIERRA LEONE SINGAPORE SLOVENIA SOMALIA SOUTH AFRICA SOUTH KOREA SOUTH WEST AFRICA SPAIN SRI LANKA ST. CROIX ST. JOHN ST. KITTS - BVI ST. LUCIA ST. MARTIN ST. THOMAS ST. VINCENT SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TANZANIA THAILAND TOBAGO TOGO TORTOLA TRINIDAD TUNISIA TURKEY TURKMENISTAN TURKS & CAICOS ISLANDS - U S A UGANDA UKRAINE UNITED ARAB EMIRATES UPPER VOLTA URUGUAY UZBEKISTAN VENEZUELA VIETNAM VIRGIN GORDA - BVI WALES WEST SAMOA WESTERN SAHARA YEMEN YUGOSLAVIA ZAIRE ZAMBIA ZIMBABWE ZIMBABWE
Province:	ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND NORTHWEST TERRITORIES NOVA SCOTIA NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON
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