IRMC Membership Form

Annual Membership Dues: $5.00

Make checks payable to IRMC
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Mail to:

Jeff Watt, Department of Mathematics
Indiana University - Purdue University Indianapolis
402 North Blackford Street
Indianapolis, IN 46202
(317) 274-4070
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Print this form and complete it to become a member or to renew your membership in IRMC:

Name: ________________________________________________________________________

School: _______________________________________________________________________

School Address: ________________________________________________________________

City: ______________________________ State: __________________ ZIP: ______________

Phone: ___________________________________ FAX: _______________________________

E-mail: _______________________________________________________________________

Web Site (if you have one): _______________________________________________________

Please indicate your home address if you prefer to receive mailings at home.

Home Address: _________________________________________________________________

City: ______________________________ State: __________________ ZIP: ______________

Additional copies of this form can be printed off the IRMC Web Site at
http://irmc.matyc.org/Membership/membership.htm