2013 Student 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.

First-time member_______ Renewing member_______

Name:______________________________________________________

University:________________________________________________

Degree Program:_____________________________________________

Degree sought:______________________________________________

Degree to be completed by (anticipated date):________________________________

Mailing address:_____________________________________________________

_________________________________________________________________

Phone:________________________ Fax:______________________________

Email:____________________________________________________________

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.

_____ AgNIC	_____ Animal Health Information
_____ Collection Management	_____ International Agriculture
_____ Social Issues / Rural Information	_____ Technology Trends

Student membership fee—$15.00/year.
Student status is available while you are enrolled in a degree program;
Student member status is available for a maximum of 5 years to accommodate those seeking degrees through Distance Education;
Student members may elect to switch to the "individual" member category at anytime.

_____Check Enclosed (Make payable to: USAIN)

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______________________________________________________________

USAIN Membership

Chris Long & Associates

P.O. Box 117

West Milton, OH 45383

voice: 937-698-4188

fax: 937-698-6153