Membership Form Check Payment : Support : Wisconsin Literacy, Inc.

Membership dues are based on the amount of students served in one year. Membership benefits and requirements are listed on the membership policy document.

Type of Membership

Renewal Membership
New Membership

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Membership Level

Each year, my literacy agency serves:

1 – 24 students = $100
25 – 74 students = $175
75 – 150 students = $250
More than 150 students = $325

Literacy Agency's Name

Contact Individual's Name

First Name *

Last Name *

Contact Individual’s Title:

Literacy Agency Address:

Country

Address Line 1

City

State/Province

Postal Code

Phone Number

Website Address

Success Story

Share a story of an outstanding learner or volunteer you would like featured:

Success Story Photo

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Bank Account Information

Account Holder

First Name

Last Name

Account Type

Checking
Savings

Account Number

Routing Number

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged