LIR 2024-2025 Membership Enrollment

Member Information

For questions, please contact LIR@nicoletcollege.edu or 715-365-4544.

Contact Information

First Name

Last Name

Email Address

Primary Phone

Phone Type

CellHome

Home Mailing Address

City

State

Zip Code

Individual or Couple Registration?

IndividualCouple

Registration Fee:

Member #2

First Name

Last Name

Same as Member #1
Different

Last Name

Email #2

Same as Member #1Different

Email #2

Primary Phone #2

Same as Member #1Different

Phone #2

Phone Type #2

CellHome
Work

Home Mailing Address #2

Same as Member #1Different

Home Mailing Address

City

State

Zip Code

How did you hear about LIR?

I'm a returning memberWord of mouthBrochureCommunity Education catalog

Nicolet College's website

FacebookNewspaperRadioLocal televisionOther

The LIR Membership year runs from July 1, 2024 to June 30, 2025, with membership fees due before attending classes. New members are welcome to join at any time. The $50 annual fee will allow you to attend any and all classes, programs, and social events.

Please list any suggestions for LIR course offerings, as well as special knowledge, talent, previous occupations, and/or experience you would be willing to share by leading a course or program.

I would be willing to assist the committee(s) checked below:

CurriculumSocial/EntertainmentServe as host for a classSet-up and take-down at an activity or presentationOther

Nicolet College will send you LIR-related communications, but please be assured we will not share your information with third-party vendors.

Member #1: Would you like your name and contact information to be included in the paper member directory?

YesNo

Member #1: Please check the boxes of the information you agree to have published in the paper member directory.

None, I do not wish to be listed in the directoryHome AddressEmailPhone number (cell)Phone Number (home)

Member #2: Would you like your name and contact information to be included in the paper member directory?

N/AYesNo

Member #2: Please check the boxes of the information you agree to have published in the paper member directory.

N/ANone, I do not wish to be listed in the directoryHome AddressEmailPhone number (cell)Phone Number (home)

Payment Information

First Name (as it appears on card)

Last Name (as it appears on card)

Credit Card Number

Credit Card CVV

Expiration Month

Expiration Year

Authnet_Hidden_Fields

Contact Information