TxCRLA Membership Application Form
New Member
Membership Renewal
Name (Dr., Mr.,
s.)______________________________________________________________
Title/Discipline
_________________________________________________________________
Institution
______________________________________________________________________
Institution
Address _______________________________________________________________
City/State/ZIP+4
________________________________________________________________
Home
Address (optional)__________________________________________________________
City/State/ZIP+4_________________________________________________________________
Work Phone
_(___)________________ ___Alternate Phone _(___)________________________
E-Mail ________________________________________________________________________
FAX
_(___)___________________________
Make check payable
to Texas College Reading 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
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