The VSRA Membership year runs from September 1, 2009 – August 31, 2010

Please print LEGIBLY and provide all information requested to ensure that you receive all local council and VSRA mailings.
Date_______________________________

Last Name____________________________________________ First Name______________________ Middle Initial ___

Home Address ______________________________________________________________________________________

City, State, Zip ____________________________________________________ Home Phone _______________________

School Division/University___________________________ School____________________ Position_________________

E-mail___________________________________________________________ Work Phone________________________

Name of Council you are joining_______________________________    New Member ___   Renewing Member ___

Type of Membership:       Professional $25 ___ Full-time Student $12 ___  Para-professional $12 ___  Retired  $12 ___

International Reading Association Member?  Yes___ No ___ If yes, list IRA Membership # ________________________


Please make checks payable to NNRC.  Give checks and membership forms to your building representative.