NAME: __________________________________________________

 

ADDRESS: ______________________________________________

 

CITY: ___________________ PROVINCE: _____________________

 

POSTAL CODE: __________ TELEPHONE: ____________________

 

EMAIL: __________________________________________________

FEE SCHEDULE:

 REGULAR                   $25.00/YEAR

                                $60.00/THREE YEARS    NEW_____ RENEWAL ______

 

STUDENT/UNEMPLOYED    $12.50 PER YEAR      NEW _____ RENEWAL ______

 

Please make cheque payable to MALT.

OPTIONAL:

 What type of library do you work in?

 

[  ] Academic

[  ] School

[  ] Public

[  ] Special

 

What is your level of education?

 

[  ] Library Technician Diploma

[  ] Library Technician Certificate

[  ] Other -__________________________________________

 

When did you graduate?______________________________

 

Any information you provide to us is for membership purposes only.

It will not be shared with or sold to any other organization.