Individual/Student Membership Form

Annual Membership Fees:

Individual: $75 / Student: $40

Membership Type:

Individual ($75)

Student ($40)

Salutation:

Mr. Ms. Mrs. Dr.

First/Given Name:

Last/Family Name:

Organizational Affiliation:

Address:

City:

State/Province:

Postal/Zip Code:

Country:

Phone:

E-mail:

How did you hear about DGS?

Colleague Website Magazine/Newsletter Conference
Other:

Would you like to know about any committees?

Communications Committee
Membership Committee
Sponsorship Committee
Student Support Committee
Journal Relations Committee
Committee on Linking Research and Government Management
2012 Conference Committee
Liaison Committee

Payment Information

Payment Method:

Credit Card
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Credit Card:

VISA MASTERCARD AMEX

Credit Card Number:

Expiration Date:

Security Code:
(printed on card)

Check: please make payable to Digital Government Society of North America and send with a copy of this form to:

Yigal Arens, Treasurer
USC - ISI
4676 Admiralty Way, Suite 1001
Marina del Rey, CA 90292