Issuu on Google+

TASH Membership

Form / Renewal

 Membership Renewal ID #__________

 New Membership " "

Referred By _________________________

Name _______________________________________________ Address (for delivery of mailed materials) ____________________________________________________________ City _________________________ State/ZIP __________________________ Home phone (

) ___________________

E-mail address primary __________________________________

Work phone (

) ___________________

E-mail address secondary ________________________________

Cell phone (

) ___________________

Membership Type Individual Member (please select one) Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly newsletter, Member Discounts (TASH Store, Publications, Webinars, Conference and more)  Individual with Disability

 Household income less than $40,000

$45

$45

 Household income between $40-60,000  Household income between $60-80,000

$85

 Household income between $80-125,000  Household income greater than $125,000  Student Member

$45

$125 $175 $215

(student membership is available for full-time students at accredited universities who are not

full-time professionals in their field) Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly newsletter, Member Discounts (TASH Store, Publications, Webinars, Conference and more), Student Section enrollment Name of University _____________________________________________  Supporting Member

$250

Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly newsletter, Member Discounts (TASH Store, Publications, Webinars, Conference and more), The Advocate Donor Newsletter, Includes $125 membership fee plus $125 tax-deductible donation

- PAGE 1 OF 2 -


 Sustaining Member

$500

Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly newsletter, Member Discounts (TASH Store, Publications, Webinars, Conference and more), Includes $125 membership fee plus $375 tax-deductible donation Organizational Member (please select one) Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly newsletter, Member Discounts (TASH Store, Publications, Webinars) and up to five discounted Conference Registrations  Annual revenue less than $2 million

$285

 Annual revenue between $2-5 million

$360

 Annual revenue greater than $5 million

$435

Contact Name (required for Organization and Library Members) _______________________________  Library Member

$300

Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections For libraries only, required for online access to the journal: Starting IP Address: ______________________ Ending IP Address: ______________________ What IP range do you want to upload? ______________________

Payment Type Funds must be submitted in U.S. dollars and checks must be drawn on a U.S. bank or an additional fee will be charged  Check (made payable to TASH)

 Visa

 Credit Card (select type)  Mastercard

 Discover

Card Number ____________________________ Expiration Date ________________ Name on Card _______________________________ Authorized Signature _____________________________ Billing Address  Check here if same as shipping address _______________________________________________ City _______________ State/ZIP ________________  I would also like to make a tax-deductable donation of $________ at this time.

E-mail the completed form to info@tash.org

Mail to: TASH

Fax to (202) 540-9019

1001 Connecticut Ave, NW, Suite 235

Questions (202) 540-9020

Washington, DC 20036


TASH Membership Application