Membership Application and Renewal Form

Name:

Title:

Institution:

Language(s):

Mailing Address:

Home Phone:

Work Phone:

e-mail:

I would like to volunteer to help with:

MEMBERSHIP DUES

Lifetime: $100.00

Professional (AY 2008-09): $15.00

Student (AY 2008-09): $ 5.00

Amount enclosed:

Renewal? Yes No

As a member you will receive an electronic copy of the HALT Newsletter 4 times during the academic year. Please be sure to include your e-mail address above. If you wish to have a paper version sent via mail instead, please check here: ______

Please mail this form to:

HALT

P.O. Box 61903

Honolulu, HI 96839-1903

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