Membership

Name *

PrefixFirst NameLast NameNickname

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Name of 2nd Adult -- Please enter for Family Memberships

First NameLast NameNickname

Address*

Street Address

CityState

Zip Code

Tell us about your work experience / professional background

0/200

Please indicate your areas of interest

Please Indicate choices

Membership Type*

One Adult (older than 18, not attending school)Family (multiple adults, one location)Youth (in school, thru M.S.)Student (under 22, in H.S., College or Tech prgm.)

The IWLA National Office bills new members on an annual, calendar year basis. If you join prior to July, one pays for the entire current year. If you join after June, one pays for half of the current year and all of the following year.

Membership Start Date*

Date

Dollars Due

Membership amount due:

USDbased on application date and membership type

Amount Due

based on date and member type

Calculation*

Amount Due