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US/ICOMOS MEMBERSHIP APPLICATION
To become a member of US/ICOMOS please print this form, fill in
the requested information, and mail with check payable to US/ICOMOS
to: US/ICOMOS, 401 F Street, NW, Room 331, Washington, DC 20001-2728.
Name:
_____________________________________________________________________
Title &
Organization:_________________________________________________________
Address:
___________________________________________________________________
__________________________________________________________________________
Work Phone:________________________
Home Phone: ____________________________
e-mail:____________________________
Fax: ___________________________________
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Membership dues
(US/ICOMOS present through 30 June 2002; ICOMOS 1 January
2002 -
31 December 2002)
___ Individual ($85) ___Library ($85) ___Student ($30)
___Institution* ($375)
___Corporate/Donor** ($1,000)
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$
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Additional Specialized Committees @ $10 / Committee
(Check committees in list below)
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$
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Voluntary Tax-Deductible Contribution
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$
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TOTAL
ENCLOSED
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$
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US/ICOMOS
Specialized Committees
( for Individual and Institutional members select one committee
per person with membership)
[ ]
Archaeological Heritage Management, Chair: Douglas C. Comer,
Maryland
[ ] Brick Masonry and Ceramics, Chair: Elena Charola,
Pennsylvania
[ ] Cultural Tourism, Chair: Alvin Rosenbaum,
Maryland
[ ] Earthen Architecture, Chair: Maribel Beas,
Pennsylvania
[ ] Historic Landscapes, Chair: Patricia O'Donnell,
Vermont
[ ] Historic Towns, Chairs: Ron Fleming,
Massachusetts
[ ] Legislation, Chair: James Reap, Georgia
[ ] Training, Chair: Roy E. Graham, Washington, DC
[ ] Vernacular Architecture, Chair: William Chapman,
Hawaii
[ ] Wood, Chair: Frank V. Sturgeon, Washington,
DC
*Institutional
membership includes membership benefits to 4 designated
staff/faculty persons. Please submit names, addresses, and
e-mails for each.
**Corporate/Donor membership includes membership
benefits to 8 designated persons. Please submit names,
addresses, and e-mail for each. |
