Clone of FCLIR Membership Form 2026-27 DRAFT

FCLIR Membership Form

Join for the May 2026 - April 2027 membership year.
Please complete all sections of the form below. Starred items are required.
Full Name

First NameLast Name
Nickname
I am a
- Your Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Your Phone Number
  Format: (000) 000-0000.
- Your Email
- Check if any of these fields have changed:
- How did you hear about FCLIR?
  
  Other
- Are you now or have you ever been affiliated with any of the Five Colleges? Check all that apply:
- Emergency Contact Name
  
  First NameLast Name
- Emergency Contact Phone
  Format: (000) 000-0000.
- What are your hobbies and interests? We use this information to pair new FCLIR members with existing members who have similar interests. (Examples: gardening, knitting, photography, cooking, wood working, literature, history, politics... whatever you want!)
- Are you interested in volunteering or joining a committee? If you check "Yes," we will contact you to discuss this further; it does not obligate you to anything!
- Are you interested in making a donation to our Membership Assistance Fund? If you check "Yes," we will send you more information in the coming weeks.
- Method of payment
- FCLIR offers membership assistance to anyone who needs it. We do not turn anyone away due to inability to pay, and we use the honor system for requests.
  
  If you choose membership assistance, you will be able to choose the amount ($0-$250) you are able to contribute towards your membership dues. Membership assitance dues must be paid via check, not PayPal.
- Choose your Membership Category
- (New SPRING) Membership Category
- Choose your Membership Renewal Category
- For PayPal payments, choose your membership category:
  prevnext( X )
  Renewing Member Dues
  Returning FCLIR membership dues for 2026-27
  
  $250.00 for each year
  
  
  
  New Member Dues
  New FCLIR membership dues for 2026-27
  
  $200.00 for each year
  
  
  
  Associate Member Dues
  FCLIR Associate membership dues (all activities except seminars) for 2026-27
  
  $125.00 for each year
- Member Assistance: Enter the amount you will pay
  Enter amount in dollars (0 to 250)
- Calculation
  HIDE ME
- Payment will be made by: (it helps the office to know what name to look for on the check)
- Name of payer
  
  First NameLast Name
- Please provide the payer with a copy of your confirmation email.
- Please make your check payable to "Five Colleges, Inc." and write "FCLIR membership" in the memo line. Mail your check to
  
  Five College Learning in Retirement
  P.O. Box 105, 202 Plain Road
  North Hatfield, MA 01066
- 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.
  
  You may opt to have your address omitted from the membership directory by checking the box below.
- Initials
  By initialing this form, I acknowledge that I have read and agreed to the statement above.
- Today's Date
  
  MonthDayYear
- When you click the SUBMIT button below, a confirmation with all the information from this form will be sent to the email address you entered. You will be redirected to the thank-you page on our web site with more information.
  
  (If you are paying via PayPal, you may have to click "return to merchant" on the final PayPal page.)
- Your PayPal payment is set up as an automatically recurring yearly subscription. You can manage your PayPal subscription from within your PayPal account. If your subscription is still active in April of 2027, we will cancel it on your behalf. You will maintain your LIR membership through the end of the 2026-27 academic year. You will need to register as a member and pay your dues again for the 2027-28 academic year.
- Should be Empty:

FCLIR Membership Form

For PayPal payments, choose your membership category:*

For PayPal payments, choose your membership category: