IALLT Membership Application/Renewal Invoice

Name _____________________________________
Position _____________________________________
Department _____________________________________
Institution _____________________________________
Address _____________________________________
City _____________________________________
State/Prov _____________________________________
Zip/Postal Code _____________________________________
Country _____________________________________
Phone _____________________________________
Email _____________________________________
Fax _____________________________________

Status (check one):
__ Renewal Membership/Subscription
__ New Member/Subscription

Check other professional organizations to which you belong:
ACTFL _____ CALICO _____ LLA _____ TESOL _____ Other _________

Check appropriate category and enter charges:
___

Educational Member, Individual (voting)

1 year = $50.00
2 year = $90.00
___

Educational Member, Retired (voting)

1 year = $25.00
___

Educational Member, Full-time Student (voting) requires sponsoring IALLT member:

1 year = $25.00

Sponsor Name:  _______________________
Sponsor Email:  _______________________   (a confirmation request will be sent)
___

Commercial Member (non-voting)

1 year = $200.00
2 year = $380.00

___

Library Subscription (non-voting). Please contact the Treasurer before ordering.
        1 Journal Volume = $60.00

TOTAL

 

Remit check payable in U.S. funds to "IALLT" -  Payment must accompany all orders.
IALLT Federal ID Number: 39-2014508

Mail invoice and check to:

Marlene Johnshoy
IALLT Membership Coordinator
395 S Pascal
St Paul, MN 55105
USA

Phone: 612.625.8848
Fax: 612.624.7514

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