**Print this form and complete for membership**
Institutional/Organizational Application for Membership
Name of Organization _____________________________________________________
Mailing Address __________________________________________________________
__________________________________________________________
Contact Person ___________________________________________________________
Phone # ( ) _____________________ Fax # ( ) _________________________
Contact Person's E-Mail Address ______________________________________________________
The contact person will be considered the representative of the institution/organization and is entitled to all rights and privledges of membership (see association brochure). Please notify ANTSHE if the person you designate as your representative should change.
____ Check or Money Order in the amount of $200 enclosed
Please return this form with your membership fee to:
ANTSHE
c/o Doane College
Janice Hadfield
303 North 52nd St.
Lincoln, NE 68504
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