Philadelphia LERA Annual Membership Form (2019-20)

LERA - Philadelphia Chapter - Annual Registration Form 2019-20

Please fill in the form below.
Full Name*

PrefixFirst NameLast NameSuffix
Organization
Affiliation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Annual membership is collected each year in the fall.

Fee structure:
- $200.....membership and all meetings (early bird $175 through 11/12/19)
- $40.......annual membership (due for all who attend more than one meeting)
- $30.......individual meeting fee
Rates for newer members who have been practicing in the field less than 5 years:
- $10.00 annual membership
- $10.00 individual meeting fee ($25 for dinner meeting, if any)
- $10.00 Student/guest who accompany a LERA member meeting fee (1x annually per individual)
You can make your payment by using the 'Submit' button below or sending a check, made out to Philadelphia LERA. Checks can be mailed to the address below. When sending in checks, please print the completed form (click on 'Print Form') and mail it with your check.

Alidz Oshagan, Treasurer

Philadelphia LERA

c/o Willig, Williams & Davidson

1845 Walnut Street, 24th Floor

Philadelphia, PA 19103
SELECT ONE
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Annual membership and all meetings (after 11/20/19)$200.00

Annual Membership (due from all who attend more than 1 meeting)$40.00

NEW: Membership - Practitioners with less than 5 yrs in the field$10.00

Membership: Students$10.00
When you click on 'Submit' below you will be redirected to PayPal. If you are mailing a check - please click 'Print Form' before submitting, then click submit and cancel the transaction once you get to PayPal.
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LERA - Philadelphia Chapter - Annual Registration Form 2019-20