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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 FOR ORGANIZATION

_____________________________________________________
Name of Organization
_____________________________________________________
Address
_____________________________________________________
City StateZip

_____________________________________________________
PhoneFAX number E-mail

MAILING INFORMATION FOR ESP PRESIDENT

_____________________________________________________
Name of Organization
_____________________________________________________
Address
_____________________________________________________
City StateZip
_____________________________________________________
Home PhoneWork Phone FAXE-mail

GRADE LEVEL

□ Pre-K

□ K-12

□ Higher Ed

ORGANIZATION DUES

1-100 members	$ 75.00	2 votes
101-200 members	150.00	4 votes
201-300 members	325.00	8 votes
301+ members	400.00	11 votes

TYPE OF MEMBERSHIP

□ New Organizational Membership

□ Renewing Organization

PAYMENT ENCLOSED

□ Check $ ________    □ Other $ _________

Please do not send cash.

Make check payable to NCESP and mail with this form to NCESP, NEA Center for Governance, 1201 16th St., NW, Suite 813, Washington, DC 20036

National Council for Education Support Professionals