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Dr./Mr./Ms./Mrs.:

Name:

Title:

Street:

Affiliation:

City/State/Zip + 4:

Mailing Address:

Phone:

Phone:

Fax:

Fax:

Email:

Email:

Can we use your Email address for communications?  (   ) Yes                (   ) No

Would you be willing to work on a Committee with the ISM?         (   ) Yes                (   ) No

If so what committee(s) / tasks interest you?

Please return to:

ISM c/o Lynn Schwabe

3349 Maple Leaf Drive

Glenview, IL 60026-1126

Or to: Kristy Shanahan

shanahan@oakton.edu