IMLA Membership Application
Copy and Print the form below and send to:
Bev Bradford
IMLA Executive Director
P.O. Box 190869
Boise, ID 83719-0869
FAX 1-866-729-4861
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IDAHO MIDDLE LEVEL ASSOCIATION
MEMBERSHIP
JULY 1, 2008 – JUNE 30, 2009
On Line Membership Application
__________________________________ __________________________________
Principal’s/Individual’s Name Principal’s e-mail address
__________________________________ __________________________________
School Building Name School Telephone
__________________________________ __________________________________
School Mailing Address City, State, Zip Code
IMLA Building Teacher Liaison:__________________________________
Liaison’s e-mail address: _______________________________________
Region: (Please circle) I II III IV V VI
Dues Category based on numbers in State School Directory.
________ 1 Individual……………………$50.00 for an Individual Membership
________ 25 or fewer staff members …$125.00 for a Building Membership
________26-50 staff members …………$200.00 for a Building Membership
________51 or more staff members……$250.00 for a Building Membership
MAKE CHECKS/PURCHASE ORDERS PAYABLE TO IMLA AND MAIL TO:
IMLA
P.O. BOX 190869
BOISE, ID 83719-0869
FOR MORE INFORMATION CONTACT:
BEV BRADFORD, EXECUTIVE DIRECTOR
208-484-5498
FAX 1-866-729-4861
