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Institute for Lifelong Education at Dartmouth (ILEAD)
10 Hilton Field Road
Hanover, NH 03755
Phone: (603) 646-0154
Fax: (603) 646-0138

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Annual ILEAD Membership Application

Dear Members and those wishing to join us:

Our membership year is from July 1 to June 30. So to be a part of ILEAD, send your annual membership fee of $60 per person.

You must be a member to be eligible to enroll in the study groups, or participate in the great opportunities ILEAD has to offer. So join ILEAD today!

Print this page. Fill out and detach the form below and return with your check(s).

Annual ILEAD Membership Application

Name(s): __________________________________________________

Occupation or Former Occupation ______________________________________________

Address: __________________________________________________

Town: ____________________________ State: __________ Zip:_______

Telephone: __________________________________________________

E-mail address: __________________________________________________

Amount enclosed ($60 x number of memberships) = $______________________

Please send completed form with Annual Membership Fee(s). Make check(s) payable to ILEAD and mail to:

10 Hilton Field Road
Hanover, NH 03755

Last Updated: 1/5/12