School 100% Membership Form

Northeast Louisiana Reading Council
100% School Membership Form

The first school to have 100% of their teachers become members of the NELRC and submit an employee list with the date that each teacher became a member will receive $200 for 2 nights lodging at the LRA Conference in Shreveport on October 26-28, 2008. Membership begins July 1 and ends June 30. The following information is required before submitting to NELRC:

Parish/District: ______________________________________________
Membership Directorís Name: __________________________________

Name of School: ____________________________________________
Phone: _______________________________________________________
Address: __________________________________________________
Principalís Signature: _________________________________________
Person submitting the form, if different than principal: _________________

Membership Directorís Signature of Verification: _____________________
Date: __________________________

Mail 100% form and/or membership forms with $20.00 dues to:
Northeast Louisiana Reading Council
c/o Nancy Smith
252Puckett Lake Road
West Monroe, LA

Fax form to: Nancy Smith if all dues have been paid.***

***Melea Walker must have all membership forms completed and receive the dues on or before submission of this form with the employee roster list and dates.
It all may be mailed at one time.

Please enclose your roster list of employees. Write the date that each teacher became a member of the NELRC.

(Office Use Only)
Date Received: _________ Time: ________am/pm
Initials: ________

Last Updated 4/17/09 11:09 pm by Site Administrator

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