LEARNING DISABILITIES ASSOCIATION OF IOWA
MEMBERSHIP APPLICATION

I am enclosing membership dues of $30 for a ____ renewal or for a  ____ new membership.

NAME_______________________________________________________________________

HOME ADDRESS_______________________________________________________________

CITY____________________________________ STATE__________ ZIP________________

HOME PHONE (_____)_________________ AEA______ EMAIL_________________________

Please check the one category that best describes your interest in learning disabilities:

___Parent   ___Professional  ___Student  ___Other (Please specify)______________________

****I would like to support the goals and projects of LDA-I.  Enclosed is a donation of $_______.
 

Please make your check payable to LDA-I and mail to: LDA-I,  321 East 6th Street, Des Moines, IA 50309