First Name
Middle Name		Name Tag
Last Name		Phone
Affiliation	Select Alabama A&M University Alabama Southern Community College Alabama State University Alcorn State University Athens State University Auburn University Auburn University-Montgomery Bevill State Community College Birmingham-Southern College Bishop State Community College Blue Mountain College Central Alabama Community College Chattahoochee Valley Community College Coahoma Community College Copiah Lincoln Community College Delta State University East Central Community College East Mississippi Community College Enterprise Ozark Community College Faulkner University Gadsden State Community College George C. Wallace Community College George Corley Wallace State Community College Hinds Community College Holmes Community College Huntingdon College Itawamba Community College Jackson State University Jacksonville State University James H. Faulkner State Community College Jefferson Davis Community College Jefferson State Community College John C. Calhoun Community College Jones County Junior College Judson College Lurleen B. Wallace Community College Meridian Community College Milsaps College Mississippi College Mississippi Delta Community College Mississippi Gulf Coast Community College Mississippi State University Mississippi University for Women Mississippi Valley State University Northeast Alabama Community College Northeast Mississippi Community College Northwest Mississippi Community College Pearl River Community College Samford University Shelton State Community College Snead State Community College Southern Union State Community College Southwest Mississippi Community College  Spring Hill College Stillman College T.A. Lawson State Community College Talledega College Tougaloo College Troy University Troy University - Dothan Troy University (main campus) Tuskegee University University of Alabama-Birmingham University of Alabama-Huntsville University of Mississippi University of Mobile University of Montevallo University of North Alabama University of South Alabama University of Southern Mississippi University of West Alabama Wallace State Community College William Carey College Other	Fax
If Other
Mailing Address		E-Mail
City		Verify E-Mail
State		Zip Code

 

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		Qty	Amount	Total
Membership Dues
	Faculty/Staff		$20.00
	Student		$ 5.00
Annual Meeting - Registration
	Faculty/Staff		$25.00
	Student		$ 5.00
	Non-Member		$45.00
Annual Meeting - Banquet
	Faculty/Staff		$25.00
	Guest		$15.00
	Student		$15.00
	Guest		$25.00
	Non-Member		$25.00
	TOTAL AMOUNT DUE