Dreiser Society: Application

[print and mail]


Name ________________________________________

Title  _________________________________________

Institution  _____________________________________

Address  ______________________________________

City __________________________ State ______________________ Zip __________

Phone  (____)__________________________________

Fax      (____)__________________________________

Email  ________________________________________

 

Please make checks ($20.00, North America ($10 for students); $30.00, elsewhere) payable to Dreiser Society.

Send check and application to:

Roark Mulligan
Secretary-Treasurer, Dreiser Society
Department of English
Christopher Newport University
Newport News, VA 23606
dreisersecretary@yahoo.com