Reinstatement Application (Student Member)

First Name:(*)
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Last Name:(*)
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Phone:(*)
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Email:(*)
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Address:(*)
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City:(*)
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State:(*)
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Zip Code:(*)
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Member Since:
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Birthday:
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RID Number:
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Highest Degree Achieved:
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Other:
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Proof of Enrollment(*)
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Opt Out
Please select what information you would like excluded from the annual directory:
Check all that apply:

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Do you want your name to be passed on to other organizations?
Please Select One(*)

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Donation
WisRID is a registered 501(c)3 organization. All donations are tax-deductible. Please indicate if you want your donation used towards a specific fund otherwise check "General Fund"
Donation Amount:
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Donation Fund

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Student Member Dues(*)
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0.00 USD