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2009-2010 NISOD Membership Application

Name of College
State/Province

President/CEO Please complete the information below. Upon receiving your college’s Excellence Award submissions, NISOD staff must contact the president for confirmation. The correct information will expedite this process and ensure all recipients will be included in the Excellence Awards booklet.
Name of President/CEO
Title
Email
Address
City
State/Province	Zip/Postal Code
Phone	Fax
NISOD Liaison Please designate someone to serve as the NISOD Liaison. This individual will be the ambassador between your college and NISOD. NISOD staff will send publications (electronic and/or print) to the NISOD Liaison, the annual membership invoice, and all correspondence. (We suggest you consider one of the following individuals: Professional Development Director, Vice President for Academic Affairs, or Executive Assistant to the President.)
Name of Contact
Title of Contact
Email
Address
City
State/Province	Zip/Postal Code
Phone	Fax
Contact Information for Person Completing Form
Name
Email
Area Code/Phone	Fax
Payment Information Annual membership fee: $995.00 (U.S. Dollars) Send an invoice. Bill purchase order # Check is on the way. Credit Card (After hitting join now, you will be taken to a screen to enter your credit card information.)

National Institute for Staff & Organizational Development (NISOD)
Community College Leadership Program | College of Education | The University of Texas at Austin
1 University Station, D5600 | Austin, TX 78712-0378
Ph: (512) 471-7545 | Fax: (512) 471-9426 | Email

2009-2010 NISOD Membership Application

President/CEO

NISOD Liaison

Contact Information for Person Completing Form

Payment Information