Given (First) Name(s):    Surname(s) (Last name):

Mailing Address:  
     Address1:          
     Address2 (opt.):
     City:                  
     State/Province:       Zip Code:
     Country:   

MEMBERSHIP CATEGORY:     -- choose category -- Lifetime ($700) Student ($15) Professional/Institutional ($40) Emeritus ($25)

MEMBERSHIP STATUS:   -- choose status -- New Member Continuing Member           TODAY'S DATE:    

CLAH dues are for the calendar year. All participants in the CLAH Program at the January meetings must be paid-up members in good standing for the previous calendar year. Annual dues for continuing members should be paid by April 30 of each year.
Year for which this payment applies:

Professional institutional affiliation:

Institutional Telephone:          Home Telephone:
E-Mail Address:          Fax:

CLAH Regional Studies/Topical Committee Membership: (you may choose more than one committee)
           (to deselect a committee hold down the "Ctrl" or "Apple" key and click)
                                       Andean            Brazilian        Central American
                                       Colonial             Caribe          Chile-Rio de la Plata
                                       Gran Colombian   Mexican        Borderland/Frontiers        Teaching & Teaching Materials

Discounted Journal Subscriptions : All correspondence regarding subscriptions should be addressed to the editorial offices of the journals in question, which are responsible for lost issues, back numbers, etc. Subscriptions are for calendar years only.
This service is not available through CLAH after April 30 of each year.

Click on the appropriate boxes: DISCOUNTED RATE FOR MEMBERS OF CLAH
                      New Renewal The Americas ($36.50/year)
                      New Renewal Luso-Brazilian Review ($45.00/year)
                      New Renewal Hispanic American Historical Review ($39.50/year)(add $12 postage and 7% GST for Canada; add $16 postage outside the U.S. and Canada)
                      New Renewal Journal of Latin American Studies ($53.00/year)

Tax Deductible Endowment Contributions:
CLAH Prizes and Awards: $
Warren Dean Awards: $
Lewis B. Hanke Awards: $
Lydia Cabrera Award: $

TOTAL ENCLOSED (Make checks out to: CLAH): : $

If you have professional news to share, please go to the "share your news" page and fill out the form there.

          ************BEFORE YOU GO ON*************

Please PRINT this completed form, then send the printed page along with your check or Postal Money Order to the following address:

Department of History and Program in Latin American Studies
University of North Carolina at Charlotte
9201 University City Boulevard
Charlotte, North Carolina 28223

 

Thank you!