2012 APRA IL Membership Application

APRA_Logo_rgb

Illinois Chapter Membership Application

Send completed application and $35 membership fee for calendar year 2012 to the following address:

Sandi Yandle

Northern Illinois University Foundation

Altgeld Hall 132
DeKalb, IL 60115

Tel: 815-753-5062

syandle@niu.edu

Paying by:

____Check (Please make check payable to APRA-Illinois.)

____Credit Card (For information on paying by credit card, please visit www.apra-il.org and click on Membership heading.)

Status: ____ New Member ____ Renewal

NAME________________________________________________________________________

TITLE________________________________________________________________________

ORGANIZATION_______________________________________________________________

ADDRESS at which you would like to receive APRA-IL mailings:

(Home___ or Work ___)

_____________________________________________________________________________

PHONE_______________________________________________________________________

FAX__________________________________________________________________________

EMAIL________________________________________________________________________

Do you have any specific suggestions for programs or locations?