Please provide the following updated information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country:
Phone
FAX
E-mail
URL
Dues Payment                  Information Update Only
Dues $ 30.00 (USD)	complete the following section if you are submitting payment by check or credit card and are mailing this form.
	DO NOT send credit card information online
Check #	P.O.
Credit Card #  Type of credit card - (Master Card or Visa)
Card Holder:
Expires:

Please submit this form to pay dues or if appropriate, to update your personal information. 

If paying dues by check please print this form and mail to Treasurer Matt Noedel.  To ensure your correct information is listed in ACSR's records, submit this form to Jackie Smithson , the Membership Committee Chair (by clicking submit form button). You may mail this form with your credit card information; DO NOT send credit card information online as this is not a secure form.