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                           APPLICATION FOR MEMBERSHIP IN
                  WYOMING LIFELONG LEARNING ASSOCIATION

  2008-2009 APPLICATION FOR MEMBERSHIP IN WLLA

 

Please check desired membership, detach and return to:

Ginny Ruckman
2710 House Ave.  
Clark Building, 302
Cheyenne, WY 82001
(307) 638-1958

 

   Memberships:


WLLA              
Institutional
    
Total

  


$15.00
$35.00

$_____

NAME_______________________________________________________________WLLA AREA #__________

TITLE/POSITION___________________________________________________________________________

ADDRESS_____________________________________________________EMAIL_______________________

CITY/STATE/ZIP___________________________________________________________________________

HOME PHONE_______________________OFFICE PHONE__________________________FAX______________

 
PRINT THIS FORM AND MAIL WITH PAYMENT TO:

Ginny Ruckman
2710 House Ave.
Clark Building, 302
Cheyenne, WY 82001
Work: 307-638-1958
gruckman@uwyo.edu

Make checks payable to: WLLA