Please print out the form below and send it with
a check for your chapter dues ($9) to:
NCPT-CSLA Treasurer Librarian, Mayodan Moravian 201 S. 7th
Ave. Mayodan, NC 27027-2509
Name: ___________________________________________________________
Address: __________________________________________________________
City: ________________________ State/Province: _________ Zip: ___________
Church/Synagogue: _________________________________________________
Address: __________________________________________________________
City: ________________________ State/Province: _________ Zip: ___________
Name of Representative: _____________________________________________
Home Phone: _________________ Church/Synagogue Phone: _______________
Fax: ________________________ E-mail: _______________________________
Check membership desired:
____ Individual
____ Church/Synagogue
Total (U.S. Dollars) $ ___________
How did you hear about CSLA?______________________________________
_________________________________________________________________
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