Rock River Reading Council

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Rock River Reading Council Membership Form

 
  
Name:
 _____________________________________________________
Mailing Address:
 _____________________________________________________
City/Zip 
 _____________________________________________________
Home Phone:
 (______)______________________________________________
E-Mail (to receive newsletters ):
 _____________________________________________________
School:
 _____________________________________________________
District:
 _____________________________________________________
Position:
 _____________________________________________________
Work Phone:
 (______)______________________________________________
Membership Type:

____ Regular Membership (enclose $10.00)

____Student Membership (enclose $5.00)

Please check if you are a member:

____WSRA Member #__________ Expiration date _________ 

____IRA Member # __________   Expiration date _________
   

Please print, fill out, and send this form along with your check payable to Rock River Reading Council to:
Shirley Rindfleisch
900 Mayer Lane
Mayville, WI 53050