2018-2019 Let's Talk LD Institutional/Community Partner Membership Application
Application for Membership
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Primary Member Information
First Name *
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Last Name *
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E-Mail Address *
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Current Mailing Address *
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City *
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State *
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Zip Code *
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Work Phone *
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Cell Phone *
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How many members of your organization (approximately)? *
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How many members of your organization would you like to be included in your Let's Talk LD Membership? *
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Signatures
You authorize Let’s Talk LD to include you on their Mailing List (YOU OPT IN). You will receive news, updates, and information about Let’s Talk LD and its programs. You understand that this membership is valid through September 30, 2019. If you wish to cancel your membership, you agree to do so in writing by emailing Membership@LetsTalkLD.org. Membership fees are non-refundable. We value your privacy and will not sell your info to 3rd parties.
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Application Date
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MAILING ADDRESS: Let's Talk LD | P.O. Box 1015 | South Pasadena, California 91031-1015 | http://www.LetsTalkLD.org | 626.644.0740
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