LREDA Application Form
Date ___________________________
New _______ Renewal
______ Member since _______
District _______________ LREDA
Chapter _____________________
Name
______________________________________________________
Employer
___________________________________________ Position
__________________
Length of employment as religious educator
___________ No. of Renaissance Modules _____ Academic Credentials
__________________________
Preferred Street Address _____________________________
City______________________ State_____ Zip________ Is address home ___ or
work __ ?
Preferred phone (_____) _____________________
Preferred Email _______________________________________________
Alternate phone or email: __________________________________________
Number of children/youth registered in RE
program: ___________
Number of adults in the congregation:
______ 150 or less
______ 150-350
______ 350-500
______ 500+
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Check Desired
Membership Category for the coming year *See notes below
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____ Active Voting Member (3 years employed as
religious educator, or 5 Renaissance modules)
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(AC)
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$140
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____ Supportive
Member (individuals who wish to
support the work of LREDA)
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(SP)
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$ 75
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____ Student/New Member
(student or less than three years experience)
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(SN)
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$ 45
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____ Life (donation
appreciated)
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(LF)
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$ ___
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Dues: $ _______
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I would also like to
join LARGE (church schools of 200+ or congs. of
550) $15
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$ _______
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I would like to
contribute to this year's Sophia Fahs Lecture Fund in the sum of...
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$ _______
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I would like to
contribute to the LREDA Endowment in the sum of...
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$ _______
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I would like to
contribute to the LREDA Scholarship Fund in the sum of...
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$ _______
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Please send LREDA
membership pin for an additional $15.
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$ _______
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____ I would like to
receive information about the LREDA Endowment
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TOTAL $ _______
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U.S. Funds Only Please
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* NOTES:
- Canadian members may deduct 15% from their
dues to partially adjust for the exchange rate.
- I understand that partial dues waivers are
available to those LREDA members in special circumstances. I am
requesting a partial waiver of my LREDA membership dues for the
membership year 2009-2010 in the amount of (not to exceed 50% of
applicable dues) ___________. The reason I am requesting this waiver
is
________________________________________________________________________________
I understand this waiver is only good for the 2009-2010 membership
year and, if circumstances warrant, I can re-apply in the future.
Signed ____________________________________
Application for membership in LREDA assumes your agreement with our
professional codes and guidelines.
Please send this completed form and funds to: LREDA, 6670 Lochdale St., Burnaby, B.C., Canada V5B 2M8
(Please be sure to affix enough postage for mail to Canada)
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