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Application for Membership

	Name:
	Title:
	Organization:
	Mailing Address:
	City, State, Zip:
	Telephone:
	E-mail:
	Web Address:

Description of Organization/Institution/Company

Statement of Interest

Nomination(s) for Executive Board

	President:
	Vice-President:
	Treasurer:
	Secretary:
	Employer Representative:
	Employer Representative:
	Two-Year College Representative:
	Four-Year College Representative:
	Student Representative:

Submit