Name: ______________________________________________________

Title: ______________________________________________________

Department: ______________________________________________________

University: ______________________________________________________

Street: ______________________________________________________

City: ______________________________________________________

State: ______________________________________________________

Country: ______________________________________________________

Zip Code: ______________________________________________________

Telephone: ______________________________________________________

Email Address: ______________________________________________________

Include in public directory of members? □ Yes □ No

Dues: Regular: $20 per year; $50 for 3 years
Student: $10 per year; $25 for 3 years

To join or renew your membership, please send a check made out to "Kenneth Burke Society" and mail it to:

Peter Smudde, Treasurer
Department of Communication
Heide Hall, Room 452
University of Wisconsin-Whitewater
Whitewater, WI 53190-1790