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IALLT Membership Application/Renewal Form

Shipping Address.
(You will be asked for a billing address, if different, when entering your credit card information.)

Name:
Position:
Department:
Institution:
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code: Note: maximum 9 characters
Country:
Phone:
Email:
Fax:

Status (check one):

Renewal Membership/Subscription
New Member/Subscription

Enter other professional organizations to which you belong (ACTFL, CALICO, LLA, TESOL, EuroCALL, NEC...):

 

Check appropriate category and charges:

1 year=$50
2 years=$90

1 year=$25

1 year=$25
Sponsor Name:
Sponsor Email: (a confirmation request will be sent)

1 year=$200
2 year=$380


Questions and correspondence can be addressed 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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