NEBRASKA STATE READING ASSOCIATION
MEMBERSHIP FORM
| First Name |
Last Name |
|
Mailing Address |
City |
State | Zip |
| Phone - home | School |
School District |
Position |
|
Local Council |
Local/State Memberships
Student Membership |
||
| Central 30100 | East Central 30200 | |
| Eastern 30300 | Metro 30400 | Mid-Nebraska 30500 |
| Ne-Kota 30600 | Niobrara 30650 | Northeast 37000 |
| Sandhills 30800 | Southwest 30925 | Waywest 30950 |
| New | Renewal |
| Check ($25.00 payable to NSRA) | Cash |
| Current IRA member # | Expiration Date |