ASSOCIATION OF ILLINOIS RURAL AND SMALL SCHOOLS

MEMBERSHIP APPLICATION

2007-2008 INVOICE

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Dr.

Mr.

Mrs.

Ms.

Name:
Position:
School:
Address:
City:	, IL
Zip:
E-mail:
Area Code:	Phone:
Fax:

Membership Category (Point and click on the category)

A.		Institutional - AIRSS	$150.00
B.		Institutional - Dual (AIRSS and NREA)	$375.00
C.		Individual	$50.00
D.		Individual - Dual (AIRSS and NREA)	$150.00
E.		Retired or Student	$25.00

Total enclosed: $

Make all checks payable to: AIRSS

Send to:	Robert G. Rogers
	219 North Branch Street
	Bluffs, IL 62621

The association encourages joining as a Dual Institutional member for $375.00. The district will become a member of the National Rural Education Association as well as Association of Illinois Rural and Small Schools. This will help in our lobbying efforts for REAP and other State and Federal Grants for Illinois schools. Complete the information below if you are joining NREA.

NREA INFORMATION (Include information for two individuals)

Name:
Title:
School:
Address:
City:	, IL
Zip:
Phone:	(Include Area Code)
E-mail:
Name:
Title:
School:
Address:
City:	, IL
Zip:
Phone:	(Include Area Code)
E-mail: