Colorado Council of Medical Librarians
JOIN CCML TODAY!

______ I would like to join CCML   (Enclosed with this form is my dues check, made payable to CCML)

Annual Dues Categories: ____ Regular $25 ___ Associate $25 ___ Student $15
(October through March): _____ $15

PLEASE CIRCLE YES OR NO BELOW:
MY HOME ADDRESS AND PHONE NUMBER MAY BE PUBLISHED IN THE ELECTRONIC CCML MEMBERSHIP DIRECTORY          YES         NO

Name:_________________________________________	____________________________________
Organization:___________________________________	____________________________________
Mailing Address:
(work)	(home)
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Telephone:___________________________________	_____________________________________
Fax:_________________________________________

E-Mail Address: _______________________________________________
(Members are automatically added to the CCML Discussion List once their membership dues have been processed.)
Website: ____________________________________

Signature: ___________________________________   Date:___________

Print, Complete, and Mail Form and Check to:
Colorado Council of Medical Librarians
P.O. Box 101058
Denver, Colorado 80250-1058

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This page was last updated on 07 FEBRUARY 2008
Direct requests for changes or questions about this page to Beth Tweed
http://www.ccmlnet.org/Membership/mem_form.html