EERC Membership Application

EERC/ORA Membership Application

Print this form and send it 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:

COMBINED Local Council/State Memberships (All Council Dues are $25 per year)