Membership Only Application / Renewal Form

Use this form if you want to apply only for membership but not attend the 2008 conference. If you want to get membership and to attend the conference, please use the Conference and Membership Combined Registration form.

Name Business Address Department College or University City/State/ZIP Phone Fax E-mail (We will use this only for conference and membership announcements, no junk.) Home Address Street City/State/ZIP Phone Fax E-mail (We will use this only for conference and membership announcements, no junk.) Membership Dues for Calendar Year 2008 Note: Fees can be paid online through Acteva. If you register online, you do NOT need to mail in the paperwork, too. The deadline for either form of registration remains the same. Regular: $65 Student/Retired/Unemployed: $45 Circle one if applicable: Student Retired Unemployed Membership fee must be postmarked by September 15, 2008, to avoid the $15 late fee if you attend the conference. Late fee is waived for residents of countries other than the USA or Canada. Payment must be in U.S. dollars and made payable to Midwest Popular Culture Association. Please return this form with your payment (payable MPCA) to: Gary Burns Department of Communication Northern Illinois University 1425 W. Lincoln Highway DeKalb IL 60115 Thank you!