Membership Application Form

Application for membership in LREDA assumes your agreement with our professional codes and guidelines.

Membership: *

New

Renewal

District: *

If Canadian, please enter CUC.

LREDA Chapter: *

If Canadian with no Chapter affiliation, please enter N/A.

First name: *

Last name: *

Employer: *

Please enter N/A if none.

Position:

Length of employment as religious educator:

Number of Renaissance Modules taken:

Academic credentials and/or RE Credentialing level:

Preferred street address: *

City: *

State/Province: *

Zip/Postal Code: *

Address is: *

Home

Work

Preferred email address: *

Please enter N/A if none.

Preferred phone: *

Please enter N/A if none.

Alternate phone or email:

Approximate number of children/youth registered in program:

Life Member donation amount: $

Optional contribution to the Sophia Lyon Fahs Lecture Fund: $

Optional contribution to the Scholarship Fund: $

Optional contribution to the LREDA Endowment Fund: $

Partial waivers are available to those LREDA members who find themselves in special circumstances. You can request a partial waiver for the current membership year not to exceed 50% of your applicable dues. The waiver is only good for one year, but you may re-apply in a future year.

If you are applying for a dues waiver, enter the amount of membership dues you wish to pay (must be at least 50% of the applicable dues for your category): $

Please explain the reason for the waiver request:

Dues payment method: *

I am paying by credit card. (Hit submit and see the confirmation page for further directions)

I am paying by check. (Hit submit, print out the confirmation page, and mail it along with your check)

Please remember that you are not considered renewed until we have your actual payment in our hands. You will receive a confirmation once we have your payment.

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