Registration: Texas Association of School Library Administrators

TASLA 2012 Membership & Workshop Registration Form

Please complete and print this form, and send it with your payment to:

Gay Patrick

2001 Columbia Dr.
Richardson, TX 75081

Name:

Title:
District/Employer:
Work Street:
Work City:
Work Zip:
Home Street:
Home City:
Home Zip:
Work Telephone:
Work Fax:
Home Telephone:
EMail:
Please mark the appropriate choice(s) below and indicate the total amount of your payment. Paying membership dues and conference registration requires a payment of $ 50.00 for regular members and $ 35.00 for associate members.
Regular Membership $25.00 New Membership $25.00 Associate (Retired) Membership $10.00
Conference Workshop Fees $25.00