 National Coalition of Independent Scholars
You may complete the form below and pay your membership via PayPal or print the page (or use the PDF form) and mail your payment to NCIS, PO BOX 838, St Helena, CA 94574-0838 |
Membership Renewal Form for 2008 |
| Salutation:
First Name:
Last Name:
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| Address:
Address (line 2):
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| City
State/Province
Zip/Postal Code
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| Country
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| Primary Phone:
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Primary eMail:
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| Website:
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Primary non-English Reading Language:
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CURRENT areas of scholarship/research
(Note discipline, geographic area, time period): |
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| Would you be willing to... |
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| Read and comment on an article by another NCIS Member |
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| Read and comment on a book draft |
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| Read and comment on a grant application |
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| Advise a Member on finding an agent |
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| Advise on publishing books and/or articles |
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| Copy research materials |
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| Translate short pieces and/or help find a translator |
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| Offer limited computer advice |
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| Assist in limited field work |
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| Offer brief temporary housing for visiting NCIS Members doing research |
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| Offer other assistance to colleagues (Please list:) |
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| Serve an on NCIS committee |
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| Serve on the NCIS Board |
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| Serve as an NCIS Officer |
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| Offer editorial assistance to The Independent Scholar (TIS) |
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| Review books for TIS |
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| Contribute articles or pieces to TIS |
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| Contribute some time to NCIS fundraising |
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| Contribute some time to NCIS publicity |
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| Assist with the NCIS web site |
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| Assist as an on-line editor for H-Scholar |
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| Offer other assistance to NCIS (Please list:) |
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Please charge the following amounts: (U.S. Currency Amts.) |
| Income |
Dues |
Dues (based on chart on left) |
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| Less than $30,000 |
$20 |
Associate Membership ($15 per person) |
$
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| $30,001-$60,000 |
$40 |
Non-US Postal surcharge ($10 per membership) |
$
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| $60,001-$80,000 |
$60 |
Donation (tax deductible in the US) |
$
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| $80,001-$100,000 |
$80 |
1 year subscriptions to TIS HARDCOPY ($15) |
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| More than $100,000 |
$100 |
Additional copies of 2008 Membership Directory @ $10 each |
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| Patron (1 yr) |
$200 |
Total:
(click "=" button to total order)
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$
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| Benefactor (1 yr) |
$500 |
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| Life Membership |
$1000 |
| Many thanks for your continued support! |
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