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Wilderness Education Association Wilderness Education Association Wilderness Education Association

Contact WEA

WEA

Wilderness Education Association
900 E. 7th Street
Bloomington, IN 47405
Ph 812.855.4095
Fx 812.855.8697


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Wilderness Education Association Membership Application

 
Section 1: User Information
 First Name*  
 Last Name*  
 Initials  
 Company*  
 Position Title  
 Mailing Address*  
 City*  
 State*  
 Zip Code*  
 Country  
 Work Phone  
 Home Phone*  
 Mobile Phone  
 Pager  
 E-mail*  
 User Name*  
 Password*
confirm password 		 
 
Section 2: Membership Information
 Referred By Wilderness Education Association Member
 
 Member ID#  
 Referred by Other  
 
Section 3: Membership Type
 Membership Type*
 $1,500.00 - Lifetime
$250.00 - Organization
$75.00 - Professional
$35.00 - Associate
$35.00 - Student
 
 
Section 4: Payment
 Payment Method*
    Credit card
    Check
    Send invoice
 
 
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