Name: ______________________________________ Title: _____________________

Organization: ___________________________________________________________

Address (Office): _______________________________________________________

City: _________________________________ State: _____ Zip: _______________

Phone: ______________ Fax: ________________ E-Mail: _____________________

Address (Home): _________________________________________________________

City: __________________________________ State: _____ Zip: ______________

Sponsoring State Director Member ________________________________________

Comments: _______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Please send mail to my (check one): ( ) Home ( ) Office address.

Membership Category (check one):
( ) Director ($400)
( ) General ($100)
( ) Sustaining ($200)

Print this form, complete it and mail with dues to:

IADLEST
2521 Country Club Way
Albion, Michigan 49224

Make check payable to: IADLEST.

Visit the IADLEST Web Site at www.iadlest.org for additional information.

Thank you for your interest in joining IADLEST!

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