ASB Membership Form 
ASB membership includes discounts on annual meeting registration and 
on subscriptions to Southeastern Naturalist (SENA), the official journal of 
ASB. 
To join or renew and pay by cash, check, or money order , complete contact 
information below, enclose cash, or check/money order payable to Association of 
Southeastern Biologists, & send by mail. To pay by credit card , complete 
contact information & credit card information, & send by reply e-mail, mail, or fax. 
If you would like further information or have questions, contact: Edgar B. Lickey, 
ASB Interim Treasurer, Department of Biology, Bridgewater College, 
Bridgewater, VA 22812; (502) 828-5426; elickey@bridqewater.edu . 
Name: 
Work E-mail: 
Personal E-mail: 
(At least one valid e-mail address is required.) 
Work Address: 
City: 
Work Telephone: 
Home Address: 
City: 
Cell Phone: 
State: 
Fax: 
State: 
Zip Code: 
Zip Code: 
Home Telephone: 
Card Type: American Express_ Discover_ Visa_ 
Master Card_ 
Card Number: 
Card CVV Number:_(Three- or four-digit number on back of card.) 
Card Expiration Date: _ _/__ 
Cardholder Name: 
(Exactly as it appears on card.) 
