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Medical Library Association | About MLA : Join MLA

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Donations are tax deductible to the extent provided by law.</td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><input name="053a" type="checkbox" id="053a" value="Disaster Relief Donation"></td> <td>Medical Library Disaster Relief Fund</td> <td><input name="053b" type="text" id="053b" value="$0.00" size="10"><br> (Indicate amount)</td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><input name="053c" type="checkbox" id="053c" value="Kronick donation"></td> <td>David Kronick Traveling Fellowship</td> <td><input type="text" name="054" size="10" value="$0.00"><br> (Indicate amount)</td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><input type="checkbox" name="055" value="Lindberg Fellowship Donation"></td> <td>Lindberg Research Fellowship</td> <td><input type="text" name="056" size="10" value="$0.00"><br> (Indicate amount)</td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><input type="checkbox" name="057" value="Shaping the Future Fund Donation"></td> <td>MLA Shaping the Future Fund</td> <td><input type="text" name="058" size="10" value="$0.00"><br> (Indicate amount)</td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><input type="checkbox" name="059" value="Other Fund Donation"></td> <td>Other fund: <input type="text" name="060" size="20"></td> <td><input type="text" name="061" size="10" value="$0.00"><br> (Indicate amount)</td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><input type="checkbox" name="062" value="Yes"></td> <td colspan="2">I want to access the <i>Journal of the Medical Library Association</i> electronically ONLY.</td> </tr> </table> <table width="95%" cellspacing="4" cellpadding="4"> <tr valign="top"> <td colspan="2"><h5>Payment Information </h5> <i>(Dues are payable in U.S. Dollars) </i></td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><b>Credit card type<font color="#f03">*</font></b></td> <td> <select name="048" size="1"> <option value="-- Select Card Type --" selected>-- Select Card Type --</option> <option value="VISA">VISA</option> <option value="MASTERCARD">MASTERCARD</option> <option value="AMERICAN EXPRESS">AMERICAN EXPRESS</option> <option value="DISCOVER">DISCOVER</option> </select> </td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><b>Credit card number <font color="#f03">*</font></b></td> <td><input type="TEXT" name="049" size="25"></td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><b>Name on credit card <font color="#f03">*</font></b></td> <td><input type="TEXT" name="050" size="25"></td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><b>Credit card expiration date <font color="#f03">*</font></b></td> <td> <select name="051"> <option value="-- Choose month --" selected>-- Choose month --</option> <option value="January">January</option> <option value="February">February</option> <option value="March">March</option> <option value="April">April</option> <option value="May">May</option> <option value="June">June</option> <option value="July">July</option> <option value="August">August</option> <option value="September">September</option> <option value="October">October</option> <option value="November">November</option> <option value="December">December</option> </select> &nbsp; <select name="052"> <option value="-- Choose year --" selected>-- Choose year --</option> <option value="2007">2007</option> <option value="2008">2008</option> <option value="2009">2009</option> <option value="2010">2010</option> <option value="2011">2011</option> <option value="2012">2012</option> <option value="2013">2013</option> <option value="2014">2014</option> </select> </td> </tr> <tr valign="top" bgcolor="#EEEEEE"> <td><b><a href="/web/20080521214808/http://mlanet.org/csc.html" target="_blank" onfocus="this.blur()" onclick="NewWindow(this.href,'details','750','450','yes','center');return false">Credit Card Security Code</a> <font color="#f03">*</font></b></td> <td><input name="052b" type="text" id="052b" size="5" maxlength="4"></td> </tr> </table> <table width="95%" cellspacing="4" cellpadding="4"> <tr valign="top" bgcolor="#EEEEEE"> <td> <input type="SUBMIT" name="Send Form" value="Verify Choices"><input type="RESET" name="Clear Form" value="Clear Form"></td> </tr> </table> <p><br> To <b>FAX</b> or <b>MAIL</b> this information, <a href="/web/20080521214808/http://mlanet.org/pdf/member_app_2006-07.pdf">download the PDF</a> (43KB) version of the application.</p> <p><b>Thanks for joining MLA! </b>MLA memberships are designed to meet YOUR needs. 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