Membership Form

Aksarben
Section of IFT

Dues for the Aksarben section are for January 1^st through December 31^st.

Options	Due	Membership	Conditions
	$10.00 per year	MEMBER: January 1^st to December 31^st	If received between November 1^st and April 30^th
	$5.00 per semester	MEMBER per semester: July 1^st to December 31^st	If received between May 1^st and October 31^st
	$12.00 per year	ASSOCIATE MEMBER: January 1^st to December 31^st	If received between November 1^st and April 30^th
	$5.00 per year	STUDENT MEMBER

Last Name:	_______________________________________________________________________________________

First Name:	_______________________________________________________________________________________

Mailing Address:
_____________
Home:
_____________
Business:

Address:
___________________________________________________________________________________

___________________________________________________________________________________

Phone:

Home:
___________________________________________________________________________________

Work:

_______________________________________________________________________

Fax: ___________________________________________________________________________________

e-mail Address:

__________________@__________________________

Company Affiliation ___________________________________________________________________________________

• Please make checks payable to Aksarben IFT

Print out this form, fill it in, and send it with your payment to:

Andrea Musel

ConAgra Frozen Foods

Six ConAgra Drive

Omaha, NE 68102-5006

Address:	___________________________________________________________________________________

	___________________________________________________________________________________

Phone:	Home:	___________________________________________________________________________________

	Work:	_______________________________________________________________________

	Fax:	___________________________________________________________________________________

e-mail Address:	__________________@__________________________

Company Affiliation	___________________________________________________________________________________