Application for ACTM
Membership
2007-2008
Please print out this page and mail to:
Retha Gipson, Treasurer ACTM, 2654 Hwy. 349, Jonesboro, AR 72404
Membership dues $15 per year
($7.50 for pre-service teachers or retired teachers)
First Name: ________________ Last Name: ______________________
Home Address: ______________________ Phone: ( )_______________
City: ________________________ State: _____ ZiP+4 _____________
School Name: ______________________________________________
School Address: _____________________ Phone: (_____)__________
City: ________________________ State: _____ Zip +4 _____________
Teaching level: Elem:__ Middle:__ Jr. High:__ High:__2-Yr. Col:__ Col:
__
Position: Teacher:__ Chair:___ Supervisor:___ Other: _______________
Dept.of Ed. Specialist Elem:______ Secondary: _____
E-MAIL: __________________________________________________
NCTM MEMBER?: _____ ____
