| Please Check One of following application types: | ____RENEWAL APPLICATION | ___ NEW APPLICATION |
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Name _________________________________________ Address _______________________________________ ______________________________________________ City __________________________________________ State ______ Zip __________ Country____________________ Postal Code ________ |
Home Phone __________________________ Work Phone __________________________ Fax _________________________________ E-Mail _______________________________ Birth Date ______________ Gender__ M __ F Employer ____________________________ Title ________________________________ |
| For demographic purposes only: (optional) Race/Ethnic
Origin: Asian _____ Black _____ Caucasian _____ Hispanic _____ Native American _____ Other _____ | |
| Choose ONE of the following ICA Membership categories: | One free division
with membership, all others $3 each. | |
|---|---|---|
| ___2. INSTITUTIONAL,
$195; HCR, Communication Theory, JOC, Newsletter, 1 Division, Directory, Preliminary Program. | ___1. Information Systems ___2. Interpersonal Communication ___3. Mass Communication | |
| ___ 3. EMERITUS, $40; HCR, Communication Theory, JOC, Newsletter, 1 Division, Directory, Preliminary Program. Must be at least 65 years of age and an ICA member for the preceding 20 years. Have ICA staff check your records. | ___4.Organizational
Communication ___5.Intercultural/Development Communication ___6. Political Communication **Check next line** ___Mandatory POLCOM surcharge ($3) | |
| ___ 5. FAMILY, $160; HCR, Communication Theory, JOC, Newsletter, 1 Division each member, 1 Directory, Preliminary Program each member. | ___7.
Instructional/Developmental Communication ___8. Health Communication ___9. Philosophy of Communication | |
| ___6. LIFE, $2,500; HCR, Communication Theory, JOC, Newsletter, Divisions, Directory, Preliminary Program, Conference Fee. Dues may be paid in four annual installments. | ___10. Communication
and Technology ___11. Public Relations Interest Group ___12. Popular Communication Interest Group | |
| ___7. SUSTAINING, $145; HCR, Communication Theory, JOC, Newsletter, 1 Division, Directory, Preliminary Program. | ___13. Feminist
Scholarship ___14.Communication Law and Policy Interest Group | |
| ___8. REGULAR, $80; HCR, Communication Theory, JOC, Newsletter, 1 Division, Directory, Preliminary Program. | ___15. Language and Social
Interaction ___16. Visual Communication Interest Group | |
| ___9. STUDENT, $40; HCR, Communication Theory, JOC, Newsletter, 1 Division, Directory, Preliminary Program. |
___17. Gay, Lesbian & Bisexual Studies |
| (Required
Postal Clause) I,____________________, hereby apply for membership in the International Communication Association and enclose $ _______ as my annual membership dues for the year. $10.00 of this amount is for a subscription to the ICA NEWSLETTER for one year. $15.00 of this amount is for a subscription to HUMAN COMMUNICATION RESEARCH for one year. $15.00 of this amount is for a subscription to COMMUNICATION THEORY for one year. $15.00 of this amount is for a subscription to JOURNAL OF COMMUNICATION for one year. | DEGREES -
List first received to last; Degree and University only. __________ _________________________ __________ ________________________ __________ ________________________ ___MasterCard ___Visa ___American Express Credit Card # _______/ _______/ _______/ _______ Exp Date_______/_______ |