First Name*

Last Name*

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Company Name:* Company Name is Required

Phone:* Phone is Required

Website: Website is not valid

Address 1:* Address 1 is Required

Address 2: Address 2 is not valid

Department (if required): Department (if required) is not valid

City:* City is Required

State:* State is Required

Zip:* Zip is Required

My company is a::* My company is a: is Required

My company does business in the following area(s) - you may choose more than one:* My company does business in the following area(s) - you may choose more than one is Required

Company Description (to be included in ALA’s Worldwide Directory):: Company Description (to be included in ALA’s Worldwide Directory): is not valid

I was referred by: I was referred by is not valid

Voting Member Name:* Voting Member Name is Required

Voting Member Job Title:* Voting Member Job Title is Required

Voting Member Email:* Voting Member Email is Required

Please list the names, email addresses, and phone numbers for each company representative joining the coalition: Please list the names, email addresses, and phone numbers for each company representative joining the coalition is not valid

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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