Membership (renewal) Application


I hereby apply for membership in the International Leprosy Association.


Email Address:

Mailing Address:

Degrees or diplomas:

Present Appointments:

Present or past connections with leprosy work:

The annual membership dues are: US$25.00

Please pay through PAYPAL.COM after clicking "Submit".

If you wish to pay by other means please download the application and mail it as indicated.  Click Here!