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MADE 2007 MEMBERSHIP FORM
**** PLEASE TYPE OR PRINT NEATLY ****

Name: ______________________________________________________________________

Position/Title: _________________________________________________________________

Institution: ___________________________________________________________________

Office Address: _______________________________________________________________

Office Phone: (________)_________________ Office Fax: (________)____________________

Office Email: _________________________________________________________________

Home Address: _______________________________________________________________

Home Phone: (_________)________________ Home Fax: (_________)___________________

Home Email: _________________________________________________________________

Please check one:
_____ I am a new MADE member.
_____ I am a returning MADE member.

As a paid member of MADE, you will receive the MADE newsletter.  Check all that apply but please allow only one mailing of hard copy, either office or home.  If you want to save MADE some money, don’t check a hard copy option at all; just check the email option(s).

I want to receive all MADE correspondence including newsletter at my (via):
___ Office (hard copy)   ___ Office (email)   ___ Home (hard copy)   ___ Home (email)

If you are interested in a MADE t-shirt, please go to the T-Shirt Order Form.

MAIL THIS FORM AND YOUR CHECK TO MADE FOR $15.00 TO:
Bobby Thrash
Pearl River Community College
101 Hwy 11 North
Poplarville, MS 39470
601-403-1142
bthrash@prcc.edu