Membership Forms

INVOICE

Kentucky Medical Library Association
c/o Debbie Sullivan, Treasurer
R. Dietz Wolfe Medical Library
Norton Audubon Hospital
One Audubon Plaza Drive
Louisville, Kentucky 40217
EIN: 20-5233173

Annual Membership Dues (January-December)

____Institutional Membership $50.00
____ Personal Membership $15.00

Please make checks payable to KMLA and send to the above address before January 15th.

Name of Member (s): ____________________________________________________________

Institution and Address: _________________________________________________________

______________________________________________________________________________

Telephone and Fax: ____________________________

E-mail address: ____________________________