Illinois Mosquito & Vector Control Association
Application for Individual Membership

Name:                                                                     

Organization:                                                                     

Address:                                                                     
                                                                                   
                                                                                   

Phone:                                                                     

FAX:                                                                     

Email address:                                                                     

Please enclose a check for $15.00 for individual membership and mail to:

Nina Krasavin, Secretary-Treasurer
Entomology Lab Bldg N104 Annex
1816 South Oak Street.
Champaign, IL 61820
Phone: 217-333-1186
Fax: 217-333-2359
Email: krasavin@uiuc.edu