Membership Application for the Student Affiliate Division of ADSA®
(This membership application needs to be printed and sent via US mail to ADSA, 1111 N. Dunlap, Savoy, IL 61874 or faxed to 217-398-4119. Thank you.)
Name _____________________________________________________________
School Address _____________________________________________________
City _____________________________ State ________ Zip Code ______________
Phone ____________________________ E-mail ____________________________
Home Address _______________________________________________________
City _____________________________ State_________ Zip Code _______________
Phone ____________________________ Date of Birth ____________
College or university in which you are a regularly enrolled student:
Dept: ________________________________________________________________
Please check one:
__Undergraduate; __Graduate;
Graduate students indicate highest degree held at present time:
__ B.S. __ M.S. __ Ph.D.
Graduate and undergraduate students indicate anticipated date of completion of work for next degree:
Division of principal interest, check one:
__ Production __ Dairy Foods
Membership/Service Type
__ Undergraduate Student Membership with on-line access to JDS: $5.00
__ Graduate Student Membership with on-line access to JDS: $10.00
__ US/Canada/Mexico: Add $99.00 for a paper copy of JDS
__ All other countries: Add $115 for a paper copy of JDS
_____________________________________________________
Signature of ADSA professional member certifying eligibility of applicant for Student Affiliate Membership.
Payment
__ Check __ MasterCard __ VISA __ American Express
Card # ___________________________________
Exp. Date _________
Signature _________________________________________________________