Full Name:

Address 1:

Address 2:

City:

State:

Zip Code:

Country:

Phone Number:

Email Address:

Select a Membership Class

Sustaining ($50 and above)
Annual ($40)
Five-Year ($160)
Student ($10-complete form below)
Life ($600-payable in quarterly installments)
Family ($50-2 annual meeting programs)
Institutional ($60)
Retired ($25)

NOTICE: For foreign memberships, add $6 per year for postage.

Recurring Billing -- by checking the box to the left and submitting this form, I authorize the Southern Historical Association to charge the credit card I have listed on an annual basis for membership dues based on the membership category I have selected (note--category amounts are subject to change; therefore, amount charged will be based on membership fees for the following year). I understand that my card will be charged October 1 each year for the following year's dues. It is also my understanding that if I choose to cancel my recurring billing arrangement I will need to contact the SHA in writing. (Recurring billing does not apply to five-year memberships.)

Field of Interest:

--Select One-- U.S. European Latin America Student Membership in the SHA

Student membership requires proof of student status.

Students (only), please complete this section:

School/College/University:

Department
(Dept of History, School of Education, etc.):

Advisor's Name: