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:____________________________________________________________
Do you wish to be a member of the USAIN Listserv? Yes_____ No_____
USAIN Interest Groups (Check your areas of interest)
_____ AgNIC
_____ Animal Health
_____Collection Management
_____Social Issues / Rural Information
_____Technology Trends
Annual Student Membership Dues
- 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.
Payment Information
_____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______________________________________________________________
Mail to:
USAIN Membership
Chris Long & Associates
P.O. Box 117
West Milton, OH 45383
voice: 937-698-4188
fax: 937-698-6153