THIS IS YOUR RECEIPT Please cut off and keeprecords LERA annual dues - PDF document

1 THIS IS YOUR RECEIPT Please cut off and
THIS IS YOUR RECEIPT Please cut off and keeprecords. LERA annual dues are not deductible as charitable contributions for federal income tax purposes but check with your accountant to see if they are deductible as ordinary and necessary business expenses. *LERA is a 501(c)(3) organization; contributions/gifts to LERA are tax deductible. Name: Dues Amount: Add’l LERA Contribution: Date Paid: Check # or Credit Card: lations Association504 East Armory Avenue Champaign, IL 61820 Phone 217.333.0072 Fax 217.265.5130 Web http://www.lera.illinois.edu Email LERAoffice@illinois.edu First Name MI Last Name ________________________________________________ Co/Univ/Org Department _______________________________________________ Street Address _______________________________________________________________________________________________________________ City _________________________________________ State ___________ Zip Country __________________________ Phone ________________________________________________________________ Fax _________________________________________________ Email __________________________________________________________ Check here to subscribe LERA Listservs: Dialog Membership Type (Please check one) Membership Dues (Please check one) 1 year 2 years 3 years Regular member $195 $390 $585 Contributing member (includes $105-$315 contribution to LERA*) $300 $600 $900 Emeritus member (at least 10 years of membership and no longer employed) $105 $210 $315 Additional family member at same address (no additional publications sent) $ 25 $ 50 $ 75 Full-time student (limited to 4 consecutive years) $ 25 Print Only Print + Online Online Only Institutional or library subscription $250 $250 Members outside of the U.S. add $20 shipping fee per year for additional postage costs $ 20 $ 40 $ 60 Calculate Dues: Method of Payment (U.S. funds only) TOTAL DUES (from above, include shipping outside US) $ ______ I would also like to make a charitable contribution to LERA(tax deductible*)LERA Annual Fundsupports overall mission and general operating expenses of the LERA, LERA communities, & initiatives ..... $ _______ John T. Dunlop Fund Check or Money Order VISA MasterCard Credit Card # Expiration Date 3-digit-code Name on Card Zip Code of Billing Address Please update the following information(Select only one) LERA Interest Sections LERA Industry Councils Academic: Return your completed form with payment to: LERA c/o University Pr