INTERNATIONAL HUMAN LEARNING RESOURCE NETWORK

Return this form before September 1, 2008 if you are NOT attending the annual conference in October 2008 but wish to remain on the IHLRN mail list and support our association. Please send either a check or money order in US dollars only payable to IHLRN  to:

            IHLRN
           c/o M.A. Bjarkman
            4119 Inglewood Blvd.
            Los Angeles, CA 90066

Call M.A. at 317-850-5111 with any questions. You will receive the annual mailing list in the fall and  What’s in the Pot? in January 2008.

Please type or print legibly.

Name(s):_________________________________________(BA, MS, PhD, blah blah, ect.) ________

Address:___________________________________________

City:_______________________________________ State:_______ Zipcode:_________________

Country:__________________________________   

Phone: (h)____________________(w) ___________________Email: _________________________

Please check as many of the following statements as apply to you:

____ My/our address is either new or corrected.

____ I/we am/are enclosing a check in the amount indicated below:

            $______ To continue on the IHLRN Mailing List ($25)

            $______ Additional donation to IHLRN Scholarship Fund

            $______Total amount enclosed

Again, we thank you for your support!!