National Association of Self-Instructional Language Programs   Membership Application
Please complete the following information. If you prefer, this form may be printed and mailed or faxed to the NASILP Secretariat.
Title	Dr. Mr. Ms. Miss First NameLast Name
Institution
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Country	United States Canada Other Other
Telephone
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Please answer the following questions so we can serve you better. Thank you.
New Application Renewal
1. Has your institution offered learner-managed language study (self-instruction) prior to application membership in NASILP? No Yes
2. How did you learn about NASILP?
3. Which languages did your institution plan to introduce in the self-instructional format within the next two years? (To make multiple selections within a table, hold down the Control key (Windows) or Command key (Mac) while selecting the desired items). Please indicate all that apply. American Sign Language Arabic Armenian Cambodian (Khmer) Cantonese Chinese (Mandarian) Czech Danish Dutch Finnish Modern Greek Haitian-Creole Hebrew Hindi Hungarian Indonesian Irish-Gaelic Italian Japanese Kazak Korean Lao Latvian Lithuanian Norwegian Persian Polish Portuguese (Brazilian) Quechua Romanian Russian Scots-Gaelic Serbo-Coratian Slovak Slovenian Swahili Swedish Tagalog Telegu Thai Turkish Ukrainian Urdu Vietnamese Other Other
4. Does your institution have a language lab or media resource center with: Audio-tape duplication VCR equipment Videodisc All None
Questions? Comments?
Institutional membership is established, initially, for a period of three academic years, for $500.00 and $200.00 a year thereafter. Please make membership fee payable to: NASILP
Please mail to:
	NASILP Secretariat at the Critical Languages Program c/o Prof Alexander Dunkel 1717 E. Speedway Blvd., Suite 3312 The University of Arizona Tucson, AZ 85721-0151