Individual/Student Membership Form

Annual Membership Fees:	Individual ($75.00)	Student ($40.00)

Member Type:	Individual Student
Salutation:	Mr. Ms. Mrs. Dr.
First/Given Name:
Last/Family Name:
Organizational Affiliation:
Address:
City:
State/Province:
Postal/Zip-Code:
Country:
Phone:
E-mail:
How did you hear about DGS?	Colleague Website Magazine/Newsletter Conference Other:
Would you like to know about any committees? (please check)	Communications Committee Membership Committee Sponsorship Committee Student Support Committee Journal Relations Committee Committee on Linking Research and Government Management 2011 Conference Committee Liaison Committee
Payment Method:	Credit Card Your data is secure. You are on a secure server with a secured connection to our processing gateway.
	Credit Card Number:
	Expiration Date:
	Security Code: (on back of card)
	Check: please make payable to Digital Government Society of North America and send with a copy of this form to: Yigal Arens, Treasurer USC - ISI 4676 Admiralty Way Marina del Rey, CA 90292