| Contact: | ___________________________________________________________ | |
| (Last, First, MI) | ||
| Title/Position: | Dr./Mr./Mrs./Ms._____________________________________________ | |
| Business: | ___________________________________________________________ | |
| Address: | ___________________________________________________________ | |
| ___________________________________________________________ | ||
| ___________________________________________________________ | ||
| Phone: | ___________________________________________________________ | |
| Fax: | ___________________________________________________________ | |
| E-mail: | ___________________________________________________________ |
Corporate Membership Dues: $ 250.00 USD |
ISCA Corporate Membership is for University Libraries, Business Libraries, and other businesses that are interested in receiving subscriptions to our Journal. Membership includes a subscription to our Journal, which is published four times a year. There are no extra fees for shipping.
Membership in ISCA involves an annual (January 1 through December 31, 2010) non-refundable fee.
METHOD OF PAYMENT: __ Check __ Money Order __ MasterCard __
Visa
Payment must be made by check or Money
Order (in U.S. dollars drawn on a U.S. bank made payable to ISCA).
Payment will also be accepted by credit card (MasterCard or Visa
only).
Credit Card Number: ___ ___ ___ ___ - ___ ___
___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___
Expiration Date: __________
Security Number on Back of Credit Card: _____________
Billing Street Address
__________________________ ZIP CODE of
Billing
Address _________________
Exact Name is it appears on card:
_________________________
Your Signature: ______________________________________
Please send completed form along with
your payment to:
ISCA - CORPORATE MEMBERSHIP 2010
975 Walnut Street, Suite 132
Cary, NC 27511-4216 USA
You may FAX
the completed form to: (919) 467-3430
E-mail: isca@ipass.net
ISCA's EIN NO: 56-1799522