Supporter Application

Basic Information

Supporter Level:

Student $5

Eureka: $10

Thinker: $25

Wonder Family: $35

Dreamer: $40

Philosopher: $75

First Name: Last Name: Email: Phone: Home Address: City: State: County: Zip: -

Work/Employment Information

Company: Department: Title:

Demographic Information

To be as inclusive as possible, we hope to collect data that will let us understand our members through a diversity, equity, and inclusion lens. The information you provide will help us tailor programming to you and allow us to see who we may be missing.

Gender

Female

Male

LGBTQIA

Prefer not to answer

Race

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Prefer not to answer

Other or more than one race

Ethnicity

Hispanic or Latino or Spanish Origin

Not Hispanic or Latino or Spanish Origin

Prefer not to answer

Age Group

Under 18

18-24 years

25-34 years

35-44 years

45-54 years

55-70 years

Above 70 years

Prefer not to answer

Education Level

Some high school

High school degree or equivalency

Some college or community college

Associate degree

Bachelor's degree

Master's degree

Doctorate degree (ex. PhD, EdD, or Professional Degree)

Prefer not to answer

Event Interest

Passion Projects

Teacher Topics

Green Futures

Shifting Perspectives

Lunch & Learn

Health & Wellness

T-Shirt Size

Donation Designation

Please choose where you would like to send your 60% donation. If you would like your donation to support membership fees for others in-need, choose "Support Another Lifelong Learner". If you would like to support a nonprofit not listed here please contact Brian.Stanley@ialr.org.

*All nonprofit orgnaizations must be a 501(c)(3) and agree to participate by submitting a W9 form before being added

*Please keep a copy of your registration confirmation email for tax purposes

Nonprofit Donation Info Please share my contact information with this organization to be recognized

Yes