Membership Form Credit Card : 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

Membership Level

Each year, my literacy agency serves:

1 – 24 students = $100 (plus processing fees)
25 – 74 students = $175 (plus processing fees)
75 – 150 students = $250 (plus processing fees)
More than 150 students = $325 (plus processing fees)

Literacy Agency's Name

Contact Individual's Name

First Name *

Last Name *

Contact Individual’s Title:

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Literacy Agency Address

Country

Address Line 1

City

State/Province

Postal Code

Phone Number

Website Address

Types of Services Your Agency Provides

Wisconsin Counties Your Agency Provides Services For

Success Story

2-3 sentence human interest story on your work to promote awareness on social media and our website

Success Story Photo

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Credit Card Information

Cardholder Name

Credit Card #

Expiration Date

Security Code

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged