WVSEA - Student Program

WVSEA - Student Program

Student
SNEA/WVSEA 2007-2008
1558 Quarrier Street
Charleston, WV 25311

Please print, complete and mail the registration form below with payment.

Name (last, first, m.i.):

_______________________________________

Mailing Address:

_______________________________________

City, State, Zip:

_______________________________________

Phone:

(_______) _______ - _____________

Social Security Number:

______ - ______ - ____________

College:

_______________________________________

Year:

Freshman
Sophmore
Junior
Senior
Graduate

000

0000

Position Code 16 Payment Method 1

Association	Membership Code	Annual Payment
SNEA	60	$15.00
WVSEA	60	$13.00
Local Chapter Dues	60	$___________
TOTAL:		$___________

Charge my credit card:
Type of Card:
Account Number:
Expiration Date: /
Name on Card:

Signature: ______________________________

I understand that the total national dues, $4.60 is for a subscription for one year to NEA TODAY, including the special TODAY'S EDUCATION issue. NEA membership is open only to those who agree to subscribe to the goals and objectives of the Association and to abide by its Constitution and Bylaws.

Member's Signature ________________________________

Date: ____ / ____ / _____

EmailAddress: ________________________________________________

Retain a copy for your records.