(PLEASE PRINT CLEARLY)

Name (including Title:  Miss, Mrs., Ms., Rev., Dr., Ven., etc.)
 

Address 

_____________________________________________

_____________________________________________

_____________________________________________
 

Email Address(es):

_____________________________________________

_____________________________________________

Phone Number(s):

(Cell)________________________________________

(Home)______________________________________

(Work)_______________________________________



Religious affiliation
 

Local Group (if applicable)
 

I apply for membership in the following category (circle one):

• Individual
• Group

I/we wish to further IALRW’s work by enclosing a contribution to (circle one or more):

• Literacy
• Service Projects (Grants)

Annual Membership fees (Individuals / Groups):

• Sterling £5.00 / £10.00
• US dollars $15.00 / $25.00
• Dutch guilders dfl 25 / dfl 30
• Rupees Rs 20 / Rs 30
• Yen Y2000 Y3500

Please make checks payable to IALRW and MAIL TO the appropriate country contact below:

Susan Caravello, IALRW Treasurer (U.S./CANADA) 
50 Harwood Dr. East, Glen Cove, NY 11542, USA
TELEPHONE:  516-671-1614
EMAIL:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Janjse Sick-Vernhout, IALRW Deputy Treasurer/Secty. (EUROPE), Achter Der Hoven 51, Deventer, Overyssel,  7419 AG, The Netherlands
TELEPHONE:  31-570-61-2545
EMAIL:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Jean Inkson, IALRW Deputy Treasurer (U.K.),
39 Woodland Pl., Aberdeen, AB15 6AP, Scotland
TELEPHONE:  44-1224-315304

Mrs. M.A. Hemalatha, Deputy Treasurer (INDIA)  
3848/3, "Prathbimaba," 12th Cross
St. Mary's Road, Karunapura,
N.R. Mohalla, Mysore 570-007, India
TELEPHONE:  91-944-805/6478
EMAIL:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Mikiko Tanaka, Deputy Treasurer/V.P. (JAPAN)
9-28-8-413 Seijo, Setagaya-ku, Tokyo, Japan. #157-0066
EMAIL:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it
_______________________

Questions?  Contact:

Judy Highfill, IALRW Newsletter Editor
EMAIL:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it

or

Kathy Matsui, IALRW President
EMAIL:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it