ACE-DHH
Application for Membership / Renewal
2000-2001

Name:  ___________________________________________________________

E-mail:  __________________________________________________________

I prefer that mailings go to:  my home ___      my office ____
 

College / University:  _________________________________________
Mailing Address:  ____________________________________________
City & State or Province:  _____________________________________
Country:  _____________________  9-digit ZIP:  __________________
Phone:  _______________________     FAX  ______________________
 
 

Home Address:  _____________________________________________
City & State or Province:  _____________________________________
Country:  _____________________  9-digit ZIP:  __________________
Phone:  _______________________     FAX  ______________________
 

Type of Membership:

_____ Regular  ($40)  _____ Emeritus  ($20)

_____ Associate ($20)  _____ Associate Member Student ($20)

Please make checks payable in U.S. dollars to ACE-DHH.
Send check and this form to:

Dr. Debbie Haydon
Wallace 245
Eastern Kentucky University
521 Lancaster Ave.
Richmond, KY  40475

RENEWAL DATE FOR DUES IS ON OR BEFORE 2001 CONFERENCE DATES.