Membership Application Form

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Contact Information:
Please let us know your name.

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Billing Contact (if not the same as above)
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Membership Tier (please select one):
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Number of Employees:
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Names and emails of employees who would like to receive event notices:
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Please indicate which professional development groups you are interested in:
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Payment Method (Please make checks payable to JLDC and mail to P.O. Box 1079, Whitehall, MT  59759, or request other arrangements below)
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