Five College Learning in Retirement
“To enrich our lives by providing forums for sharing the pleasures of active learning”

Full-Time Membership Application/Renewal

Print out this form, fill it out and mail it to
5CLIR, 9 Mason Hall, Smith College, Northampton, MA 01063
Please make checks payable to 5CLIR

Name____________________________________ Phone_____________________

Address__________________________________ Town/Zip___________________

Email ________________________________

For first-time joiners, second semester: January 1–June 30, 2008, dues are $115.

5CLIR offers financial assistance to applicants who qualify. Our Membership Assistance Fund was created for the express purpose of making membership in 5CLIR available to everyone. Choices follow:

____ I am an individual with income of $24,000 or less per year or am one of a couple with joint income of $32,000 or less per year. I enclose $100 for my annual dues.
Second-semester joiner: I enclose $60.

____ My circumstances create need greater than above. Must contact 5CLIR Treasurer directly (Charlie Klem, on 548-7945) before taking this option.

The Membership Assistance Fund was created in order to provide dues assistance for those who otherwise could not join 5CLIR. We depend upon generous members to contribute the considerable amount used each year for this aid to fellow members. Please consider sending a contribution with your dues. Your contribution to the 5CLIR Membership Assistance Fund is tax-deductible.

Enclosed is a gift to the Membership Assistance Fund in the amount of $______

Please make checks payable to 5CLIR and mail to
5CLIR, 9 Mason Hall, Smith College, Northampton, MA 01063

The membership year begins on July 1 and the annual dues are $200. They entitle each member to participate in seminars, special programs and summer programs (some of which may carry a cost) and various other activities through the year; to receive all publications; to join a committee; to vote in annual elections; and to receive a membership card which provides borrowing privileges at the libraries of the five colleges.

Those persons whose initial application for membership is made after the start of the fall seminars, or who were Trial members the first semester, may join for a half-year (January 1 to June 30) for $115.00, with the rights and responsibilities cited above. This privilege can be extended only to first-time applicants. Those qualifying (see above) for reduced dues may become members for $60.

If a “fully paid” member is unable to register for a fall or spring seminar, a refund of $50.00 can be applied for in writing. The request must be received by March 15 of the current membership year.

In case of emergency or illness, I would like you to notify:

Name (please print)___________________________________________

Phone (with area code)________________________________________

I wish to become a member of Five College Learning in Retirement for the period of July 1, 2007 – June 30, 2008. I recognize that my address, email address and telephone number will appear in the 5CLIR membership directory and my photograph may appear in the Newsletter or on the website unless I request an exemption in writing. I understand that being a member includes participating as a full, contributing, member of any seminar in which I enroll and that there are expectations of regular attendance in all seminars (see catalog for more details on registration and seminars).

Signature:______________________________________________ Date______________________