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2014 Institutional Membership Form

Please note that, for all USAIN members, the membership year is from January 1 to December 31. Membership dues are not pro-rated.

Primary Member

First-time member_______             Renewing member_______

 

Name:____________________________________________________________

 

Organization:______________________________________________________

 

Title:_____________________________________________________________

 

Academic Rank: ___________________________________________________

 

Mailing address:____________________________________________________

 

_________________________________________________________________

 

_________________________________________________________________

 

Phone:________________________ Fax:______________________________

 

Email:____________________________________________________________

 

USAIN Interest Groups

Check any you would like to join. There is no additional charge for Interest Groups.

 

_____ Agricultural Economics Research, Information, and Education (AERIE) _____ AgNIC
_____ Animal Health Information _____ Collection Management
_____ International Agriculture _____ Social Issues/Rural Information
_____ Technology Trends

 

USAIN Listserv

I am already subscribed to USAIN-L _____ 

Yes, please add me to USAIN-L at the email address listed above _____
No thank you. I do not wish to subscribe at this time _____

Secondary Member

First-time member_______             Renewing member_______

 

 

Name:______________________________________________________

 

Organization:________________________________________________

 

Title:______________________________________________________

 

Mailing address:_____________________________________________________

 

_________________________________________________________________

 

_________________________________________________________________

 

Phone:________________________ Fax:______________________________

 

Email:____________________________________________________________

 

USAIN Listserv

I am already subscribed to USAIN-L _____ 

Yes, please add me to USAIN-L at the email address listed above _____
No thank you. I do not wish to subscribe at this time _____

USAIN Interest Groups

Check any you would like to join. There is no additional charge for Interest Groups.

 

_____ Agricultural Economics Research, Information, and Education (AERIE) _____ AgNIC
_____ Animal Health Information _____ Collection Management
_____ International Agriculture _____ Social Issues/Rural Information
_____ Technology Trends

 

Annual Institutional Membership Dues

$250.00_____Institutional (includes a primary member and a secondary member.)

Payment Information

_____Check Enclosed (Make payable to USAIN)

 

_____Institutional Purchase Order __________________________________

 

Credit Card No. (Visa or Mastercard)_______________________________ Exp. Date _____

 

Security Code on back of card ____

 

Cardholder's Name:______________________________________________________ (as it appears on the card)

 

Billing address (on the account): _______________________________________________

 

______________________________________________________________________

 

Signature______________________________________________________________

 

Mail to:

 

USAIN Membership

Chris Long & Associates

P.O. Box 117

West Milton, OH 45383

voice: 937-698-4188

fax: 937-698-6153