Membership Forms 2009 registration

Membership Form 2009

 

Professional Development Membership Form

District Contact First Name:
District Contact Last Name:
District Contact E-mail: (i.e. Jane@School.edu)
(All confirmation and correspondence will be sent to the above e-mail address)
District Name:
District Address:
District City, State, Zip:
District Phone Number:
District Fax Number:
Membership Fees:
Please enter the number of students and select your charge rate:
Number of Students:
Membership Rate:	Small District $750.00 Medium District $1000.00 Large District $1500.00
**Total Amount Due:	**Price discount for Charter Membership is not included in this total. Discount will be adjusted on the final invoice.
PO Number: