RSS MEMBERSHIP FORM

IMPORTANT: Thanks for printing clearly and providing all the requested information. If your institution

has multiple campuses, please note yours. You will receive an e-mail confirmation.

Name(s) (last, first): ___________________________________________________________

Institution: ______________________________________

Rank: ________________________

Complete Mailing Address: ______________________________________________________

E-mail: ______________________________________________________________________

Phone (indicate whether home or office): _____________________________________________

Areas of concentration:
1) ________________________

2) ________________________

DUES SCHEDULE

Please circle the amount you are paying at this time.

professor, administrator: 1-year ($20)
Adjunct, part-time: 1-year ($10)
Student, retired, or unemployed: 1-year ($10)

Mail this form, along with payment (a check or money order in U.S. funds), to University of Delaware (RSS), c/o Philip Goldstein, AA Program, University of Delaware, 333 Shipley St., Wilmington, DE 19801.