North Dakota Reading Association Membership Application

NAME __________________________________________________________________

First MI Last

ADDRESS _______________________________________________________________

Street/P.O

_________________________________________________________________________

City State Zip Code

WORKPLACE____________________________________________________________

State Zip Code

PHONE H ( ___ )________________ PHONE W ( ___ )____________________

EMAIL Address Required ____________________________________________________

Highest Degree Earned ____________________________________________________

Please check: POSITION: __________________

___New Member (1^st Year)

___Renewing Member

___Changes or corrections are noted above with previous data

For local membership write check to local council.

Are you an IRA member? ______ IRA membership number: ____________________

You may join IRA by connecting to IRA @ www.reading.org and select membership, journals etc.

STATE MEMBERSHIP CHAIR: Cheryl Hagar, 2420 2nd Ave. SW, Minot, ND 58701-3332