NAME______________________________________________________
        Surname            First Name            Title


INSTITUTIONAL
ADDRESS___________________________________________________
                                              Zip/Country

Phone:____________ Fax:____________ E-Mail:_______________


HOME ADDRESS______________________________________________
                                              Zip/Country

Phone:____________ Fax:____________ E-Mail:_______________


PREFERRED MAILING ADDRESS (check one) [ ]INSTITUTIONAL [ ]HOME

TYPE OF MEMBERSHIP (Check one)
( ) First time Personal Membership: $50.00
( ) Personal: $60.00 ( ) Student: $30.00 ( ) Emeritus: $30.00
( ) Personal (Latin America, Puerto Rico, Caribbean): $30.00
( ) Student (Latin America, Puerto Rico, Caribbean): $15.00
( ) Emeritus (Latin America, Puerto Rico, Caribbean): $15.00
( ) Institutional (All countries): $110.00
( ) Institutional Sponsoring Member (All countries): $500.00


( ) Contribution to the Marietta Daniels Shepard
                           Scholarship Endowment $_________

( ) Contribution to Enlace Program $_______________________

( ) Contribution to the Salalm Endowment $_________________

                                        TOTAL: $___________


VISA___  MASTERCARD___  EXPIRATION DATE ____/____/____

CARD NUMBER __________-__________-__________-_________


SIGNATURE_____________________________________________