Membership

Printable Form

New Member ____        Membership Renewal____

Name (Dr., Mr., Ms.)_______________________________________________________________

Title/Discipline ___________________________________________________________________

Institution ______________________________________________________________________

Institution Address _______________________________________________________________

City/State/ZIP+4 _________________________________________________________________

Work Phone _(___)________________Alternate Phone _(___)____________________

E-Mail ________________________________________________________________

FAX _(___)_____________________

Make check payable to Texas College Reading and Learning Association [EIN # 94-3468149] in the amount of $10 for state membership only. Mail the above information and check to the membership chair at the following address:

       Kathy Stein, TxCRLA Membership

Sul Ross State University
Box C-132 400 N. Harrison St.
Alpine, TX 79832