member

	Children's Literature Association of Utah
Membership Application

__________________________________ Last Name	__________________________________ First Name	_____ MI
__________________________________ Title or Position	__________________________________ Institution Name
__________________________________ Home Phone #	__________________________________ Work Phone #

Mailing Address	__________________________________ Street Address	__________________________________ City
Mailing Address	__________________________________ State	__________________________________ Zip Code

________________________________________________________________ E-Mail Address

This Membership Is:	____New ____Renewal	Would you like to help?	____No ____Yes!
Is this a new address?	____No ____Yes	How?	____Reader ____Nominate books ____Committee Member

Please Return to:

Holly Whistler
9178 S. 1500 W.
West Jordan, UT 84088

Membership Fee: $15.00

Make checks payable to: CLAU