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Fax to 413-577-3194

Membership Application

2008

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Law and Society Association

Mail to address below

Print and fill-in this form. Then fax it or mail it to LSA.

Name:         _____________________________________________________________

Address:     ______________________________________________________________

                 ______________________________________________________________

Office Phone:    ____________________;  Fax:    ____________________

E-Mail address:    _________________________________

Institutional Affiliation:     ________________________________Position: _______________

New Membership    _________         Renewal of  Membership     _________

Research Interests Codes (see list for numbers)    _______; _______        Racial/Ethnicity Codes (see list for numbers) _____; _____

Dues are by annual income (U.S. $ - those paid in other currencies must use the appropriate conversion rate). Check the applicable category:

_____ Student                  $36                  _____ Under $15,000            $36
_____ $15-35,000           $62                  _____ $35,001-60,000          $88
_____ $60,001-90,000    $124                _____ $90,001-125,000        $155
_____ >$125,000            $186                _____ Special International     $21

Voluntary Contributions to support Association Prize Funds and Special Funds for Minority Fellowships and International Travel Support (enter amount) [Contributions to LSA are tax deductible for U.S. federal taxpayers]. Prizes described here.

 

 Harry J. Kalven Prize $____ J. Willard Hurst Prize $____ Herb Jacob Book Prize $ ____

 

 International Prize $____ Student Prizes $____ Article Prize $ ____

 

 Dissertation Prize $____ General Contribution $____    

 

 Minority Fellowship $____ Int'l Travel Fund $_____    

TOTAL PAYMENT $___________

For Credit Card Payments:

__ VISA  __ MasterCard ___ AmExp  #______________________________  exp. date _____

Name on Account _______________________________________________________

Address on Account    _______________________________________________

     _______________________________________________

City ______________ State ___________ Zip _________  Country ____________

Signature ______________________________________________________________

Checks should be mailed to:    Membership Coordinator, Law and Society Association,
                                               University of Massachusetts, Draper Hall, 40 Campus Center Way
                                               Amherst, MA 01003-9244 USA