ACIS MEMBERSHIP APPLICATION

As a member of the Association for Computer and Information Science, you are entitled to reduced rates on all conferences and
proceedings, participation in the ACIS activities and committees, and the right to hold office.

PLEASE PRINT OR TYPE:

Mr. Ms. Dr. Prof.
First Name Middle Initial Last Name

Dept/Section
University/Company
Street
City State ZIP
Country
Phone () Fax ()
E-Mail
Highest Degree Year Graduated
University

Research Interest :

Payment Information
Regular Membership: $80.00 $
Student Membership: $40.00 * $

*For student membership rates, please provide certificate of enrollment, inquire with your registrars office.
Total $
Method: Check (From only U.S.A. or Canada) Money Order Master Card Visa
If you are paying by credit card, please fill out the following:
Credit Card Number
Expiration Date
Exact Name as it appears on the card
V-code (last 3 digits on the back of your card)

Signature __________________________________________________ Date ________________

Note:
1. You may fax the completed form on (989)-774-3728