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Midcontinental Chapter of the
Medical Library Association

* Colorado * Kansas * Missouri * Nebraska * South Dakota * Utah * Wyoming *

Membership Form

Fill this form out, then print it, and mail it with your $15 check to:

Peggy Mullaly-Quijas
Executive Secretary, MCMLA
P.O. Box 2218
Lee's Summit, MO 64063-2218

Make checks payable to MCMLA

Name
Title
Library
Institution
Street Address
City: State: Zip:
Phone Number: Fax:
E-mail:
   

IMPORTANT - Please answer the following:

  1. Are you a current MLA member? Check one:
    Personal Institutional Both Personal/Institutional Not a Member


  2. Are you a new member of MCMLA? YES NO


  3. The directory will be available on the MCMLA web site in PDF format.

    May we list your full directory information on the MCMLA website? YES NO

                If NO, may we list your name and e-mail address? YES NO
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