**Print this form and complete for membership**
Individual Application for Membership
Name __________________________________________________________________
Address _______________________________________________________________
________________________________________________________________
Phone # ( ) _____________________ Fax # ( ) ________________________
E-Mail Address _______________________________________________________
If you are a student or academic professional, please tell us the school with which you are associated.
Name of school/college ____________________________________________________________
Address _______________________________________________________________
________________________________________________________________
Please indicate your status:
Membership Fee:
___ Student $10 ___ Alumnus $20
___ Academic Professional $40 ___ Friend $50
Check or Money Order in the amount of _________ enclosed.
Please return this form with your membership fee to:
ANTSHE
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