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WSRA Full-Time Student Membership Application Form

This is not an electronic order form!

Dues may be tax deductible. Please fill out this application form, click submit, PRINT the formatted confirmation page and mail it with a check for $10.00 made payable to WSRA at:

WSRA Membership
N7902 East Friesland Rd
Randolph, WI 53956

This application is for:
Renewal New Membership
Name
Home Address
Apt/Suite
City
State
ZIP
Place of Employment/School District
Duties, Title & Level/Dept
Home Phone
Work Phone
Email Address
Are you a member of International Reading Association?
YES NO
Are you a member of a local reading council?
YES NO
If YES, please indicate which one(s):
55050 Central Wisconsin 55250 Interlake 55750 Racine-Kenosha
55075 Door County 55300 Lake Superior 55825 Rock River
55100 Eau Claire Area 55350 Madison Area 55800 St. Croix Valley
55125 Fox Valley 55400 Mideast 55850 South Kettle Moraine
55150 Greater Bayland 55450 Midwest 55860 Southern Lakes
55200 Headwaters 55500 Milwaukee Area 55875 Washington-Ozaukee
55210 Hidden Valley 55525 Northeast 55900 Waukesha County
55550 Northwest 55950 Wolf River
Send me information about:
Local Councils WSRA Committees
   
Information supplied will be put in WSRA's membership directory. Your membership is valid for one (1) year from date of submission and you expiration date will appear on your mailing label.
 

 
This page last updated June 09 2006

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