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.

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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:

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