TASH Membership Form / Renewal

Membership Renewal ID #__________ New Membership " " Referred By _________________________

Name _______________________________________________

Address (for delivery of mailed materials) ____________________________________________________________City _________________________ State/ZIP __________________________

Home phone ( ) ___________________ E-mail address primary __________________________________

Work phone ( ) ___________________ E-mail address secondary ________________________________Cell phone ( ) ___________________

Membership Type Individual Member (please select one)

Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly newsletter, Member Discounts (TASH Store, Publications, Webinars, Conference and more)

Individual with Disability $45

Household income less than $40,000 $45 Household income between $40-60,000 $85

Household income between $60-80,000 $125 Household income between $80-125,000 $175

Household income greater than $125,000 $215

Student Member $45 (student membership is available for full-time students at accredited universities who are not full-time professionals in their field)

Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly newsletter, Member Discounts (TASH Store, Publications, Webinars, Conference and more), Student Section enrollment

Name of University _____________________________________________

Supporting Member $250

Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly newsletter, Member Discounts (TASH Store, Publications, Webinars, Conference and more), The Advocate Donor

Newsletter, Includes $125 membership fee plus $125 tax-deductible donation

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Sustaining Member $500

Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly newsletter, Member Discounts (TASH Store, Publications, Webinars, Conference and more), Includes $125 membership fee

plus $375 tax-deductible donation

Organizational Member (please select one)Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections, TASH In Action bi-weekly

newsletter, Member Discounts (TASH Store, Publications, Webinars) and up to five discounted Conference Registrations

Annual revenue less than $2 million $285 Annual revenue between $2-5 million $360

Annual revenue greater than $5 million $435Contact Name (required for Organization and Library Members) _______________________________

Library Member $300

Member benefits: Annual subscription to RPSD, Annual Subscription to TASH Connections

For libraries only, required for online access to the journal:Starting IP Address: ______________________

Ending IP Address: ______________________What IP range do you want to upload? ______________________

Payment TypeFunds must be submitted in U.S. dollars and checks must be drawn on a U.S. bank or an additional fee will be charged

Check (made payable to TASH) Credit Card (select type) Visa Mastercard Discover

Card Number ____________________________

Expiration Date ________________Name on Card _______________________________

Authorized Signature _____________________________

Billing Address Check here if same as shipping address _______________________________________________City _______________ State/ZIP ________________

I would also like to make a tax-deductable donation of $________ at this time.

E-mail the completed form to info@tash.org Mail to: TASH Fax to (202) 540-9019 1001 Connecticut Ave, NW, Suite 235

Questions (202) 540-9020 Washington, DC 20036