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Institutional Membership Application

The Immersive Learning Research Network (iLRN) is delighted that you are interested in becoming an institutional member of our organization. Please submit the following information and an iLRN Representative will be in touch shortly.

Organization Information

Name of Organization

URL of Organization

Application Type

Primary Contact Information

First Name

Last Name

Informal Name

Job Title

Department

Address

City

State / Province

Zip / Postal Code

Country

Phone Number

Email Address

Business Office Contact (if different than above)

Address

City

State / Province

Zip / Postal Code

Country

Phone Number

Email Address

Additional Comments

Please type additional comments in the text box below.

Membership Fee

Your institutional membership fee is $ USD.

If you would like to make a payment by credit card, please use the widget below. If you do not make a payment now, we will send you an invoice.

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