MEMEBERSHIP FORM

YES! I WOULD LIKE TO SUPPORT THE CENTER’S TEACHING, RESEARCH, AND OUTREACH PROGRAMS ON THE AMERICAN SOUTH.

Please type or print the information requested. Send the registration form and check, if applicable, to Friends of the Center, Center for the Study of Southern Culture, The University of Mississippi, Post Office Box 1848, University, MS 38677-1848.

NAME______________________________________________________________________________________________

ADDRESS___________________________________________________________________________________________

CITY STATE ZIP________________________________ OCCUPATION/POSITION______________________________________________________________________________

INSTITUTION/ORGANIZATION________________________________________________________________________

HOME TELEPHONE BUSINESS TELEPHONE_______________________________________

FAX E-MAIL______________________________________________________________________

I would like the following membership type:_____________________________________________________________

I am contributing $_________________________________________________________________________________

Check or money order enclosed? _________

Credit Card # (if applicable): _________________________________________________________________________

Exp. Date:________________________________________________________________________________________

Signature:________________________________________________________________________________________