Name:

Office Address:

Home Address:

Preferred Mailing address (check one): Office Home

University Affiliation (if any):

Telephone: Office Home

Email Address:

Fax Number:

Modern Language Association Member? Yes No

If you do not agree to any other information, the directory will list your name and university affiliation or State/Province/Country. If you do not wish even this listing please check the following box:

I do not wish to have my name listed at all in the membership directory.

Membership Dues (U. S. Funds only or international money order)

U.S. and Canadian individual --$16
Student or unemployed--$16
U.S. or Canadian Library--$16
Foreign individual or library--$16

Please send form and your check for dues to:

Marilyn Seymour
3334 23rd St. NE,
Hickory, NC  28601

 

 

(Make checks payable to the "Doris Lessing Society").