ASSOCIATION OF ILLINOIS RURAL AND SMALL SCHOOLS

MEMBERSHIP APPLICATION

2009-2010 INVOICE

Click here for a printable version in PDF format.

Please enter the information in the box. Use the tab key to move to the next entry.

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:	Steven Breckon
	2656 N. Hwy 94 P.O. Box 340
	LaHarpe, IL 61450

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: