Winter 2015 TLJ

2015 Individual Membership
Calendar Year JAN – DEC
• Dues must be postmarked or entered online by February 1, 2015 to vote
for association officers.
• New member You are encouraged to join the New Members Round Table
in addition to Round Tables or Interest Groups in your specialized area.
• Members falling into two or more categories of membership shall pay the
highest applicable dues.
• Individual membership dues are non-refundable and non-transferable.
• Except for $3.71 of your dues for this year’s subscription to the Texas
Library Journal and TLACast, your TLA dues are tax deductible as a
charitable donation.
To join or renew online (preferred) visit www.txla.org
SECTION I – PERSONAL & DEMOGRAPHIC INFORMATION
First name _____________________ Middle name_____________________
Last name_______________________________________________________
Nickname (If any) _________________________________________________
TLA membership number, if known ___________________________________
Employment: Institution/Library_____________________________________
Campus Branch/Department________________________________________
BUSINESS Street Address________________________________________
City__________________________State______ ZIP+4__________________
Business Phone_ _______________________ Fax_______________________
HOME Street Address____________________________________________
City__________________________State______ ZIP+4__________________
Home Phone____________________ _Cell Phone_______________________
Preferred Email _ ________________________________________________
Secondary Email_________________________________________________
Your Social Media Handles (if applicable):
Twitter_________________________ Facebook________________________
Linked In________________________ Other___________________________
Preferred mailing address: o Home
o Do not publish my home information
o Work
Please note your preference regarding useful and timely electronic
information from TLA and occasionally from screened outside
organizations:
o From TLA and outside organizations – or – o From TLA only
o I do NOT want to be auto-subscribed to Unit electronic lists.
Optional information – Response is purely voluntary; this
information will not appear in the membership directory:
How old are you
o 25 and under
o 26 – 35
Are you: o Female o Male
Which of these categories defined by the US Census Bureau best
describes your race/ethnicity Select all that apply:
o Black or African American
o American Indian or Alaska Native
o Asian
o Native Hawaiian or Other Pacific Islander
o Hispanic/Latino origin
o White person not of Hispanic/Latino origin
o Person of other race(s); please identify________________________
_______________________________________
How far away from the center of a large Texas city do you live (Large
cities include Austin, Amarillo, Corpus Christi, Dallas, El Paso, Fort
Worth, Houston, Laredo, Lubbock, San Antonio)
o within 5 miles
o 5 – 15 miles
o 16 – 30 miles
What is your highest level of education
o High School or GED
o Associate Degree
o Bachelor’s Degree
o Master’s Degree
o Doctorate
o None of the above
Do you have formal library/information
training or certification at any of the following levels
(check any that apply)
o Library/Media Specialist Certification
o Bachelor’s Degree
o Master’s Degree, non-ALA accredited school
o Master’s Degree, ALA-accredited school
o Doctorate
Library Type Affiliation
o Academic
o Public
o 36 – 45
o 46 – 55
o 56 – 65
o 66 or over
o 31 – 60 miles
o 61 – 100 miles
o Farther than 100 miles
o School
o Special
My Birthday is:
Month__________________
Day_ ______
o Does not apply
Which college or university granted your Master’s Degree
in Library and/or Information Science
o Sam Houston State University
o Texas Woman’s University
o University of Houston, Clear Lake
o University of North Texas
o University of Texas at Austin
o Other Texas school (please identify)_____________________________
o Non-TX American school (please identify)_______________________
o International program (please identify)___________________________
3355 Bee Cave Road, Suite 401, Austin, TX 78746-6763_
512/328-1518 • 800/580-2852 • FAX: 512/328-8852_
Email: tla@txla.org
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