Institutional Membership Form

Is the membership for an individual OR for an institution?*

Individual Membership - $40.00
Institutional Membership - $350.00

Is this a first time membership or a renewal?*

Joining AGLS
Membership Renewal for 2024-25

Institution*

(e.g. State University, Bigtown College-Secondcampus, etc.)

Name of Person Submitting Membership Form*

First Last

If this is for an individual membership, please supply name and contact information for the person who is to receive the membership benefits. If for an institutional membership, please supply the name and contact information for the person who is submitting the form for the institution.

Preferred email of individual*

Campus phone of individual*

Is there a gen ed committee/program/office/department/school on campus?*

Yes
No

What is the official name of the above gen ed entity?

(e.g. Committee for Gen Ed Reform, School of General Education, State U Roadway to Success, etc)

If available, please provide a web address to the above entity.

(e.g. www.stateuni.edu/gened)

Title of person overseeing the general education entity on campus

(e.g. Director/Chair of General Education, Chair/member of a gen ed committee, gen ed faculty, etc.)

Name of person currently in the position above

First Last

Preferred email of person overseeing the gen ed entity

Campus phone of person overseeing the gen ed entity

Would you like to pay now with a credit card OR have AGLS send you an invoice?

Please send an invoice for the institutional membership to the following person – provide name and email above. (e.g. Jane Smith, jsmith@unitown.edu) NOTE: Registrations are not active until payment is received.

Pay now via credit card / Paypal
Invoice me

Please enter name and email of person to receive email with e-invoice

Acknowledgment*

PayPal is the AGLS credit card processing portal. You DO NOT need to have a PayPal account. You can pay with a credit card. Simply select the option to pay as a guest/with a credit/debit card.

I Understand

Total

$0.00

Comments

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2024-25 Institutional Membership