Please Print This Page (acrobat and printer icon to the left) and Mail in with Check
to:
ISPI-SA
c/o Will Dozier
12326 La Barca
San Antonio, TX 78233
Your Name: ___________________________________________________________________________
Annual Dues: (check one) Make Checks Payable to ISPI-SA.
____ $20.00 Standard Chapter Membership
____ $15.00 Chapter Membership with discount for International Members
____ $5.00 Chapter Membership for Full-Time Students
___ New Member ___ Renewal
Please send newsletters to the following Email: ____________________________________________
Home Address:
Street: ___________________________________
City, State Zip: ___________________________________
Phone: _________________ Fax: __________________
___ OK to use it, ___ Do Not Use W/O prior notice
Email: _____________________________
(Leave blank if you do NOT want email for ISPI business to this address)
Office Address:
Your Title: ___________________________________
Department/Office: _________________________________
Street/PO Box ___________________________________
City, State Zip: ___________________________________
Phone: _________________ Fax: __________________
___ OK to use it, ___ Do Not Use W/O prior notice
Email: _____________________________
(Leave blank if you do NOT want email for ISPI business to this address)
| Comments |
|






