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Name: |
_____________________________________________________ |
Mailing Address: |
_____________________________________________________ |
Phone: |
_____________________________________________________ |
E-Mail (to receive newsletters ): |
_____________________________________________________ |
District: |
_____________________________________________________ |
Membeship Type: |
____ New Membership ____Renewal |
Other Memberships: |
Member WSRA # __________ Member IRA # __________ |
Include a check payable to: |
| Headwaters Reading Council * $10.00 Early Bird Special (postmarked by September 15th) * $12.00 after September 15th * $5.00 student or retired educator |
Please print, fill out and send this form to:
Jane Nicholl, Membership
P. O. Box 2648
Eagle River, WI 54521