Individual Membership Form:

This application is for:  Individuals and students who are interested in literacy issues or who have literacy challenges

Please select your membership level below:

Associated Membership Fee:

Individual Membership:  A person interested in literacy and in supporting the work of the Greater Baton Rouge Literacy Coalition.

 $25

Student Membership:  A person with literacy challenges and/or who is enrolled as a student.

 $0

Memberships are from January 1st to December 31st of each calendar year.
 Please make checks payable to the Greater Baton Rouge Literacy Coalition.

Personal Information - Please Tell Us About You:
Name:
Mailing Address:
City: State: Zip:
Home Phone:
Work Phone:
Email:

Which ONE Category Best Describes You?

Literacy Volunteer

Adult Education Student

Educator

College Student

Literacy Advocate

Other (please specify):

Please Check One:

I am interested in attending monthly Stakeholder Advisory Council Meetings.

I am not interested in participating in the Stakeholders Advisory Council at this time.