| IALEP Membership Application |
| Print out this application form and mail the completed application along with your check or money order in US funds payable to IALEP to: | |
|
(circle one) |
IALEP PO Box 11437 Torrance, CA 90510-1437 |
| Name: | ________________________________________________ |
| Position or Rank: | ________________________________________________ |
| Agency: | ________________________________________________ |
| Mailing Address: | ________________________________________________ |
| ________________________________________________ | |
| ________________________________________________ | |
| Phone: | ________________________________________________ |
| FAX: | ________________________________________________ |
| eMail Address: | ________________________________________________ |
IALEP membership (Active or Associate - circle one) |
$75 | $75.00 | |
| Optional Chapter Membership: | |||
| Florida - Southeastern US | $16 | _________ | |
| Illinois | $0 | _________ | |
| Regional Association - New Jersey, New York, Pennsylvania | $15 | _________ | |
| Southwest - Arizona, Colorado, So. Nevada, So. Utah, New Mexico | $20 | _________ | |
TOTAL |
_________ | ||
| (IALEP IRS ID number: FEID 43--1569519) | |||
Last Update on 01/11/07