THE SOCIETY FOR THE STUDY OF THE INDIGENOUS LANGUAGES OF THE AMERICAS

APPLICATION FOR MEMBERSHIP

Please print this form, provide the information requested, and return it to the address below.

Name:

Mailing Address:

Telephone:

Fax:

E-Mail:

Homepage:

American Indian languages, families, or areas that you are well acquainted with:

Field of specialization, special interests:

Please indicate if you do not wish SSILA to post any of the following online: ____ mailing address ____ e-mail address ____ specialization/interests

Dues for one or two years in advance (2010-2012) at the same rate __________

Contribution (__Ken Hale Prize, __Travel Fund, __unrestricted) __________

TOTAL PAYMENT: __________

__ Check or Money Order enclosed (on US or Canadian bank, made out to “SSILA”)

__ Credit card payment authorized (Visa or Mastercard only; provide information below)

Acct. Number : __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expires (MO/YR): ____ / ____

Signature: __________________________________________ Date: ________________

Name as it appears on card: _____________________________________________________

SEND THIS FORM TO:

SSILA, PO Box 1295, Denton, TX 76202, USA (ivy@ivydoak.com)