EERC/ORA Membership Application

Print this form and send it (with a check for $25 made out to EERC) to:
Barbara McKillip
PO box 10246
Eugene, OR 97440

Date (example:12/15/98):
First Name: Last Name:
Address:
City: State: Zip Code :
Phone (Home): Phone (Work):
Email Address:

Local Council: Emerald Empire Reading Council
School District:
School:
Position:

Please check:
New Member Renewal
If you are an IRA member, please list your IRA# (on your Journal label)


Please Indicate:
Classroom Teacher:
Elementary Title I/Special Ed
Middle School/Junior High Administration
Secondary Other:

COMBINED Local Council/State Memberships (All Council Dues are $25 per year)
Capital (40100) Mid-Columbia (40400) Portland (40700) Three Sisters (40900)
Driftwood (40200) Mid-Valley (40450) Rogue Valley (40800) Vineyard Valleys
Emerald Empire (40300) Mt. Valleys (40500) Sunset (40860) Umpqua