LREDA Application Form
Date ___________________________
New _______ Renewal
______ Member since _______ District
______________________________ LREDA Chapter ________________
Name ______________________________________________________
Employment ___________________________________________ Position __________________
Length of employment ________ No. of Renaissance Modules _____ Academic Credentials __________________________
Preferred Street Address _____________________________ City______________________ State_____ Zip________ Is address home ___ or work __ ?
Preferred phone (_____) __________________ Preferred Email _______________________
Alternate phone or email: __________________________________________
| Check Desired Membership Category for the coming year *See notes below |
| |
____ Active Voting Member |
(AC) |
$140 |
| ____ Supportive Member |
(SP) |
$ 75 |
| ____ Student/New Member |
(SN) |
$ 45 |
| ____ Life (donation appreciated) |
(LF) |
$ ___ |
Dues: $ _______ |
| I would also like to join LARGE (church schools of 200+ or congs. of 550) $15 |
$ _______ |
| I would like to contribute to this year's Sophia Fahs Lecture Fund in the sum of... |
$ _______ |
| I would like to contribute to the LREDA Endowment in the sum of... |
$ _______ |
| I would like to contribute to the LREDA Scholarship Fund in the sum of... |
$ _______ |
| Please send LREDA membership pin for an additional $15. |
$ _______ |
| ____ I would like to receive information about the LREDA Endowment |
TOTAL $ _______ |
| U.S. Funds Only Please |
* NOTES:
- Canadian members may deduct 15% from their dues to partially adjust for the exchange rate.
- I understand that partial dues waivers are available to those LREDA members in special circumstances. I am requesting a partial waiver of my LREDA membership dues for the membership year 2008-2009 in the amount of (not to exceed 50% of applicable dues) ___________. The reason I am requesting this waiver is
________________________________________________________________________________
I understand this waiver is only good for the 2008-2009 membership year and, if circumstances warrant, I can re-apply in the future. Signed ____________________________________
Application for membership in LREDA assumes your agreement with our professional codes and guidelines.
Please send this completed form and funds to: LREDA, 6670 Lochdale St., Burnaby, B.C., Canada V5B 2M8
(Please be sure to affix enough postage for mail to Canada)
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