Join or Renew Your FCLIR Membership

Join or renew your FCLIR membership
Date

MonthDayYear
Date
Name of member*

First NameLast Name
Address of Member*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Member*
E-mail of Member*
Name of Emergency Contact*

First NameLast Name
Phone of Emergency Contact*
Membership Category (amount includes our online processing costs)*
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RENEWING Full year membership($250.00 one-time payment)

FIRST TIME Full year membership($200.00 one-time payment)

Associate Membership: for former Full Members (No seminars or voting rights) ($125.00 one-time payment)

Membership Assistance: Full year membership (For individuals experiencing financial hardship)( $ Free one-time payment)
Fill in amount between $0 and $250.
Membership Assistance Amount (Between $0 and $250)
Type amount above.
Name of payer, if other than member

First NameLast Name
To make a donation to the FCLIR Membership Assistance Fund, which offers financial assistance to support membership dues of fellow members, please click here.

This contribution is tax-deductible to the extent allowed by law.
As a member of Five College Learning in Retirement, I recognize that my address, email, and telephone number will appear in the FCLIR membership directory and my photograph may appear in the newsletter or on the website unless I request an exemption in writing. I acknowledge this statement by entering my initials below.
Initials*
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Join or renew your FCLIR membership