Form Center

2. If you have a question or concern you would like IPELRA to address, please submit this form.
   We will try to address your request in a timely manner. If you need immediate assistance, please contact Secretariat Debi Stensland at 847.378.7711
4. First Name*
5. Last Name*
7. City*
8. State*
9. Zip*
11. Phone Number*
12. Email Address
14. What is the nature of your request?*
16. Would you like to be contacted concerning your request?*

    1. Yes

    1. No
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit Submit and Print

* indicates a required field