Please print out and complete the form below
and submit it with your dues payment. 

Name                                                                                                                         

Institutional affiliation                                                                                               

Home address                                                                                                          

City                                                                     State                  Zip                        

Telephone                                                                                                                  

Fax                                                                                                                               

Email                                                                                                                             

Work address                                                                                                               

City                                                                               State                  Zip________

Telephone                                                                                                                       

Fax                                                                                                                                   

Email                                                                                                                                

Preferred mailing address:                home                                   work

Regular member $35                   
Student member $15                   
Retired Member $15                    
Institutional Member $45                    

(Please add $5.00 for Canadian members and $10.00 for overseas members)

Life Membership $750               

Additional ways to support the work of AJHA:

                  DONORS: $250 a year, $500 every 2 years, $1,000 one time, or any larger amount through estate planning -- to support AJHA publications

                  SPONSORS: $125 a year; $250 every 2 years; or $500 one time -- to support graduate student participation in the annual convention

                  SUPPORTERS: $50 a year, $100 every 2 years, or $200 one time -- to support the AJHA general operating fund

Contributors are recognized at the annual convention.

Mail to:
Carol Sue Humphrey, AJHA Administrative Secretary
OBU Box 61201
500 W. University
Shawnee, OK  74804-2590

AJHA publishes a printed directory of members on a regular basis.  Please indicate below what material you wish to be included in such directories.

                  all of my contact information

                  only my work contact information

                  I do not wish to be included in the printed directory

Signature:                                                                                                                                    

AJHA also publishes an online membership directory.  Please indicate below what material you wish to be included online.

                   all of my contact information

                   only my work contact information

                   I do not wish to be included in the online directory

Signature:                                                                                                                                    

AJHA Interest Survey: (please circle no more than 5)

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