NLLEA Membership Application Form

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Associate Membership $500 Annually

Agency Membership Price of Level Selected (Price Range: $250 - $1250 Annually)

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Individual Membership $50 Annually

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

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Family NameBusiness Name

Please select a valid membership option and fee item if exist

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