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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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