Membership Application - Literacy Action Network

Primary Member Information

Name*

First Last

Title*

Consortium/Organization*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Legislative District Information

Please let us know your legislative district as we may ask you to reach out to your local legislator(s) regarding various ABE policy and funding issues.

MN House

MN Senate

Additional Member Information

If you are signing up multiple members please download this file and open in your preferred spreadsheet application. Fill out your member list, rename the file to refer to your organization, upload to the file uploader field below.

Upload Member List

Accepted file types: xls, xlsx, csv, Max. file size: 64 MB.

Using the sample member list spreadsheet file (link above) please fill out your member list and upload the file here. Rename the file to identify your organization. XLS, XLSX, and CSV file formats are acceptable.

Total Number of Members*

Price: $40.00

Total

$0.00

Payment

Total membership dues are calculated above. Please write down your membership dues amount for your reference when making a payment. If you choose to pay online today you will automatically be redirected to our online payment processor administered by Literacy Minnesota. If you select "bill me" an invoice will arrive in the mail. A confirmation email will be sent to the primary member please print the email for your records.

Payment Method*

Bill me
Pay with a credit card or bank account (write down your total to input when prompted)

Purchase order number (if applicable)

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.