NAAC Membership Form

Use this form to register for NAAC membership, Federal ID #: 45-0467504.

Please mail your information to the address provided below:

Please enter the following information:

Name:

Title or position (if applicable):

University or Organization:

School or Department:

Address:

City:

State: Zip:

Phone # (please include area code): Extension:

Fax # (please include area code):

E-mail address:

Type of Membership

Individual Membership (Includes Newsletter) $40.00
Institutional Membership (Includes Newsletter) $80.00
Student & Physician Resident Membership (Must provide proof of student status) $20.00

Journal of Agromedicine

Individual Member discounted price $52.50
Individual Non-Member price $75.00
Institutional discounted price $87.50
Non-NAAC Institutional member price $125.00

NOTE:
Make checks payable to North American Agromedicine Consortium and remit payments to:

Catherine Reavis, EdD, RN,CS, FNP, Treasurer
Director, Rural Nursing Outreach Program
Georgia Southern University School of Nursing
PO Box 8158
Statesboro, GA 30460-8158
T: (912) 681-5739

Webmaster: Magdy Akladios, PhD, PE, CSP, CPE, CSHM
Last modified: September 21st, 2007