Maine Reading Association

Membership Application

Please print this application, fill in information and send form with dues to:

Robyn Clark-Henry

305 Bunker Hill Rd.

Jefferson, ME. 04348

Last Name:__________________________________

First Name: _________________________________ Initial:_______

Home Mailing Address: ____________________________________

________________________________________________________

City ______________________________________ State: ________

Zip Code:_________________ Home Phone:___________________

School Phone:_________________________

Job Position:_____________________________________________

email: __________________________________________________

Please check on below:

Professional Member - $15.00

Full-Time Student Member- $10.00

Retired Member - $10.00

Parent - $10.00

I.R.A. Membership Number:_________________________

I would like information sent to me about joining I.R.A.

Remember your dues are tax deductible if you itemize.