ASSOCIATION FOR HISPANIC CLASSICAL THEATER, INC.
DUES PAYMENT & CONFERENCE REGISTRATION FORM
To pay membership dues and/or conference registration:
1. Please indicate your dues and registration categories and then fill out the bottom portion of this form.
2. Send the entire form (with your check or credit card information) to: Prof. Anita Stoll, First Vice-President AHCT, 2081 Lamberton Road, Cleveland Heights, OH 44118 (firstname.lastname@example.org).
I. AHCT Membership Dues
The AHCT membership year runs from April through March. On the newsletter mailing label, the date by your name shows the end of the period for which membership has been paid (e.g., 3/07 = dues paid through March 2007, time to renew).
Dues Categories (Please mark the category that applies to your membership.)
A) Individual Membership, $30 annually ____; B) Discounted Individual Membership (Retired Members & Students), $20 annually _____; C) Patron Membership, $35 annually with the privilege of requesting the loan of one video from our archives without charge ____; D) Sponsor Membership, $60 annually with the privilege of requesting the loan of two videos from our archives without charge and invitation to attend and participate in the annual meeting of the Board ____; E) Institutional Membership, $60 annually with the privileges of D above _____; F) Sustaining Membership, $510 payable one time only, with the privileges of requesting the loan of two videos from our archives annually without charge and invitation to attend and participate in the annual meeting of the board. _____.
II. AHCT Conference Registration (Note: conference participants must also have paid current membership dues.)
Please indicate your registration category: A) AHCT Member, $95 _______; B) Graduate Student Auditor (for students who attend conference as auditors only – does not include banquet), $30 ________; C) Student Banquet Attendance (for student auditors who also attend the banquet), $15 _________; D) Late Fee, to accompany conference registration paid after February 9, 2008, $15 _________. After February 18 payment must be made at the conference.
Payment may be made either by check or by Credit Card—Visa or MasterCard only.
Checks should be payable to AHCT.
Name_________________________________ Title & Affiliation______________________________
Phone_______________(off.ice) _________________(home) E-mail ___________________________
For Payment by Check (payable to AHCT): Check no. __________ Amount ____________
For Payment by Credit Card:
Address_______________________________ State ______ Zip Code _________ Country ________
(Please provide address to which your statements are sent)
Visa ___ MasterCard ____ Card Number _______________________ Expiration date_______
Last three digits of CVV number (on back side of card) ______________ Amount ___________
(must be at least $15)
Signature _______________________________ (8/07)