Name of Institution__________________________________

Address:   ________________________________________

City:   ___________________________________________

State: ___________Zip: ______________

Contact Person:    ___________________________________

Title:     ___________________________________________

Office:   ___________________________________________

Telephone Number:  __________________________________

Fax Number:    ______________________________________

Email Address:  _____________________________________

Please return this membership form, via mail, with your membership fee of $100 to:

Joan M. O’Brien

Office of Planning, Training and Institutional Research (OPTIR)

Villanova University

800 Lancaster Avenue

Villanova, PA 19085-1699

Phone: 610-519-4558

e-mail: joan.obrien@villanova.edu

Checks should be made payable to:

Villanova University - OPTIR

If there are multiple contact persons, use the back of this sheet.