FELLOWSHIP OF LITERACY PROVIDERS

APPLICATION FOR MEMBERSHIP

  

            CONTACT NAME: _____________________________________________

 

            ROTARY CLUB: _______________________________________________

 

            ROTARY DISTRICT: ___________________________________________

 

MAILING ADDRESS:

 

            Street: ________________________________________________________

 

            City: _________________________________________________________

 

            State: __________________________ZIP Code: ______________________

 

            Country: ______________________________________________________

 

            Telephone #: ___________________________________________________

 

            E-mail: ________________________________________________________

 

DOES YOUR CLUB HAVE A SPECIFIC AREA OF CONCERN?

IF SO, CIRCLE THE AREA OF CONCERN:

 

VOCATIONAL TRAINING – COMPUTER ASSISTED LEARNING – JOB COUNSELING – TUTOR WORKSHOPS – HIGH SCHOOL DIPLOMAS – WORKPLACE LITERACY – RESOURCE MATERIALS – STUDY SKILLS – DIAGNOSTIC TESTING – ENGLISH AS A SECOND LANGUAGE – SCHOLARSHIP PROGRAMS – MENTORING PROGRAMS – ADULT EDUCATION – PRE-SCHOOL AGE CHILDREN – SCHOOL AGE CHILDREN – WOMEN EDUCATION – OTHER: __________________________________________________

________________________________________________________

 

MEMBERSHIP DUES: USD$20.00 PAY TO: Fellowship of Literacy Providers

MAIL CHECK AND APPLICATION TO:  Fellowship of Literacy Providers

PDG Hal Shipley

P.O. Box 598

Clarksburg, CA USA 95612-0598

You can also pay $ 20 online at:

Please send a mail to the Treasurer Halshipley @ cs.com immediately after the payment.