LLI MEMBERSHIP APPLICATION 
This form is for use when Fall and Spring course registrations are not underway. When course registrations are underway, please include membership dues with your course registration fees.
Please send or bring this form with your check to 
Lifetime Learners Institute, 188 Richards Avenue, Norwalk CT 06854. [West 013 ] 

LLI membership dues: $30.00 for the academic year, June 1, 2008 to May 31, 2009.

PLEASE PRINT
Name: __ Male __ Female
Address:
City/State/Zip
Telephone:
Your e-mail address: 
Birth date (Important! Required by Norwalk Community College): 
Emergency contact and phone:
Membership dues  $ 
 

LLI MEMBERSHIP APPLICATION 
This form is for use when Fall and Spring course registrations are not underway. When course registrations are underway, please include membership dues with your course registration fees.
Please send or bring this form with your check to 
Lifetime Learners Institute, 188 Richards Avenue, Norwalk CT 06854. [West 013 ] 

LLI membership dues: $30.00 for the academic year, June 1, 2008 to May 31, 2009.

PLEASE PRINT
Name: __ Male __ Female
Address:
City/State/Zip
Telephone:
Your e-mail address: 
Birth date (Important! Required by Norwalk Community College): 
Emergency contact and phone:
Membership dues  $ 
 

Lifetime Learners Institute - For information: contact LLI  Webmistress: Marilyn Bakker