Membership Form

Name ___________________________________________________________

Address _________________________________________________________

City/State/Zip _____________________________________________________

Phone ___________________________________________________________

E-mail ___________________________________________________________

Membership Category:

Professional Interpreter ($10 membership) _____

Student Interpreter ($5 membership) ________

If you are a professional interpreter, do you hold a certification or state credential? Would you please share your credentials with us? (optional)

_________________________RID/ISAS/Other

Print this form and mail it, with a check or money order to:

LEIRID, c/o Shelly Stearns, 306 E. Washington, DeSoto, IL 62924