IJCRA Registration

Contact Information
First Name:			Last Name:
Title & Position:			Institution:
Street Address:			City:
State/Province:			Zip Code:
Country:			Home Phone:
URL:			Office Phone:
E-mail:
Secondary E-mail:

Subscription Rates
Per Year
	Individual (US $100) Institutional/Departmental (US $785) Library (US $1050)		$

	Number of Years

Gift to Adopt a Library Any amount is appreciated			$

		Total	$

Billing

Check drawn on a U.S. bank made payable to WACRA® or VISA/MasterCard only.

Credit Card
Cardholder Name
Card Number
Expiration Date

Note: This form is not submitted electronically. You must print a copy first.

Please mail (or fax) this form with your payment to:

WACRA®
23 Mackintosh Avenue
Needham (Boston) MA 02492-1218 U.S.A
Tel. 781.444.8982 Fax: 781.444.1548
e-mail: wacra@rcn.com

Please note that this is an interactive form designed to calculate your total automatically.
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WACRA® Conference Office
3817 Tonsley Place
High Point, NC 27265 U.S.A
Telephone: +336.404.6256 Fax: +336.307.3185
email: smithdmwacra@triad.rr.com

Needham, Massachusetts Home Office
WACRA®
23 Mackintosh Avenue
Needham (Boston), MA 02492-1218
U.S.A.

Telephone: +781-444-8982
Fax: +781-444-1548
email: wacra@rcn.com