IACD Membership Form

Fil in and print out the form below, then mail it to the address listed at the bottom.

Name
Institution/Organization
Position
Address
City
State
Zip
Phone
E-mail

Return this form to:

Illinois Association for Cultural Diversity
IACD/Simpkins 207
Department of English & Journalism
Western Illinois University
Macomb, IL 61455-1390
Phone: 309/298-2057 • FAX: 309/298-2974

Illinois Association for Cultural Diversity
IACD/Simpkins 207
Department of English & Journalism
Western Illinois University
Macomb, IL 61455-1390
Phone: 309/298-2057 • FAX: 309/298-2974