and
Virginia State Reading Association
2011 - 2012 Membership Form
Virginia State Reading Association
2011 - 2012 Membership Form
The VSRA Membership year runs from September 1, 2011 – August 31, 2012
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 ___
___
I
wish
to
join the Secondary Reading Council for an additional $5.00
International Reading
Association Member? Yes___ No ___ If yes, list IRA Membership #
________________________Would
you
like
information
about the International Reading Association:
Yes ___ No ___
Please make checks payable to NNRC. Give checks and membership forms to your building representative.
