AHNCA Membership Form

Date:

Name:

New Member ____ or Renewal _____

Membership category (check one):
Regular Member ($35) _____ Supporting Member ($50) _____ Patron ($100) _____
Benefactor ($200) _____ Retired ($20)______ Student with I.D. ($20) ___

Preferred mailing address:

Address you wish to be listed in membership directory:

Telephone numbers you wish to be listed (designate work or home or cell):

E-mail:

Fax number/s:

Field of specialization/current project. Graduate students, please list dissertation topic, university and name of adviser. If dissertation is just completed, state date of completion:

Include check (and student i.d. if warranted), and mail to: Janet Whitmore, Membership Coordinator; Association of Historians of Nineteenth-Century Art; 5614 N. Wayne Avenue, #1 Chicago, IL 60660