MAA-Michigan Optional Dues Form

Instructions

Please print out this page, fill in the appropriate information and mail it and a check to our Section Secretary, Nancy Colwell, at the address below. Make checks payable to MAA-Michigan.
Nancy Colwell
Secretary/Treasurer Michigan Section MAA
Department of Mathematical Sciences
Saginaw Valley State University
University Center, MI 48710-0001

Complete the Following

Check One:

______ Individual Annual Member Dues: $15.00

______ Individual Sustaining Member Dues: $30.00

______ Small Institution Annual Member Dues: $40.00

______ Large Institution Sustaining Member Dues: $70.00

Please provide the following information for an individual member.

Name: ____________________________________

School: ____________________________________

School Address: ____________________________________

City: ____________________________________

State: ____________________________________

ZIP: ____________________________________

Phone: ____________________________________

e-mail: ____________________________________

web site: ____________________________________

fax: ____________________________________

Please provide the following information for an institutional member.

Name of contact person: ____________________________________

School: ____________________________________

School Address: ____________________________________

City: ____________________________________

State: ____________________________________

ZIP: ____________________________________

Phone of contact person: ____________________________________

e-mail of contact person: ____________________________________

web site of math department: ____________________________________

department fax: ____________________________________

______	Individual Annual Member Dues:	$15.00
______	Individual Sustaining Member Dues:	$30.00
______	Small Institution Annual Member Dues:	$40.00
______	Large Institution Sustaining Member Dues:	$70.00

Name:	____________________________________
School:	____________________________________
School Address:	____________________________________
City:	____________________________________
State:	____________________________________
ZIP:	____________________________________
Phone:	____________________________________
e-mail:	____________________________________
web site:	____________________________________
fax:	____________________________________

Name of contact person:	____________________________________
School:	____________________________________
School Address:	____________________________________
City:	____________________________________
State:	____________________________________
ZIP:	____________________________________
Phone of contact person:	____________________________________
e-mail of contact person:	____________________________________
web site of math department:	____________________________________
department fax:	____________________________________