2006 LATIN AMERICAN JEWISH STUDIES ASSOCIATION 2006

Darrell Lockhart, University of Nevada-Reno, Dept. of Foreign Languages & Literatures,
241 Edmund J. Cain Hall/100, Reno NV 89557-0034
FAX: 775-784-4197 • E-mail: lockhart@unr.edu
http://www.acad.swarthmore.edu/lajsa

INDIVIDUAL MEMBERSHIP for Calendar Year 2006: o Renewal o New Application
(Dues are for the 2006 calendar year: January 1 – December 31)

Please print or type all information requested.

____________________________________________ ____________________________________ ________
Surname(s) First Name(s) Initial

______________________________________________________________________
Surname under which you should be indexed on LAJSA database

________________________________________________________________________________________________________
Mailing Address

________________________________________________________________________________________________________
City, State, Zip, Country

Home Telephone: ___________________________ Business Telephone: ____________________________

FAX: _________________________ E-mail Address: ___________________________________________
Please print e-mail address exactly as it appears in correspondence to you

Countries of Interest: Country #1 _________________________; Country #2 __________________________

Subjects of Interest: Subject #1 __________________________; Subject #2 ___________________________

Membership Information
Membership includes 2 issues of Latin American Jewish Studies, the Membership Directory, registration at individual member’s rate for LAJSA conferences, and access to the listserv (LAJSA-List). To access LAJSA-List, send an email to listproc@lists.cc.utexas.edu. Leave the “Subject” line blank. The body of the message should read: SUBSCRIBE LAJSA-List YOUR NAME YOUR EMAIL ADDRESS, substituting your own name and email address.

A gift in any amount will endow our future fund. Donors of $500 or more will be listed as Patrons.
All gifts and contributions to LAJSA a non-profit, tax exempt corporation, are tax deductible.

Total Payment Enclosed $__________________________________

Method of Payment:
o Check payable to LAJSA (in U.S. dollars drawn only on a U.S. bank)
o U.S. dollar money order
o Credit Card
o VISA o MasterCard

VISA or MasterCard Number: /__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/

Expiration Date: ______/______

Signature: ______________________________________________________________ (do not forget to add $2.00 handling fee)

If payment is by credit card, you may fax this form to (775) 784-4197. All other forms of payment must be mailed to LAJSA at the Reno address above.