I hereby apply for membership in the International Leprosy Association.
Name:
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!
