Please print out this form, complete it out and mail it along with your membership payment, to the address given below. For a PDF copy of this form see the Related Items section in the right column.

MAILING INFORMATION:

____________________________________________________
Last Name                                First Name                 Middle Initial

Address_____________________________________________

City_______________________State______  Zip ___________

Home Phone:________________________

Work Phone:________________________

Fax Number:________________________

E-mail Address:_______________________________________

JOB TITLE____________________________________

JOB CATEGORY: Please check the appropriate classification

_____Building and Grounds Maintenance and Repair

_____Security Services

_____Food Services

_____Health and Student Services

_____Paraprofessional

_____Secretarial, Clerical, Administrative Services

_____Technical Services

_____Trades, Crafts, Machine Operators

_____Transportation, Delivery, Vehicle Mechanics

GRADE LEVEL: Please check the appropriate levels

_____Pre-K

_____K-12

_____Higher Ed

LEADERSHIP POSITIONS HELD:

Local_______________________________________________

State_______________________________________________

National_____________________________________________

MEMBERSHIP INFORMATION: Please check one

_____I am a NEW member

_____I am a renewing member

PAYMENT INFORMATION: Please check one

_____I am ESP and want to have an Individual, voting membership ($20.00)

_____I am ESP and want to have an Associate, non-voting membership ($10.00)

_____I am Not ESP and would like to have an Associate, non-voting membership ($10.00)

 Please make your check payable to the NCESP and mail a copy of this membership form to :

Attn: NCESP

National Education Association

Center for Governance
1201 16th Street, NW # 813

Washington, D.C. 20036

****NOTE****

• Only checks and money orders are acceptable. PLEASE DO NOT SEND CASH.

• Please keep a copy of this form for your own records.

• NOTE: This form is for Individual and Associate members. If you are joining as an ESP Organization, please use the Organization Membership Form.
  

  
  National Council for Education Support Professionals