NYSMEA
membership form
Please send $20.00 and the information below to NYSMEA
at
520 Davie Street, Westbury NY, 11590-5908
Membership runs
to the following June 1st
| Please provide the following contact information:
Name Mr. Mrs. Ms. Dr.
_______________________________________
Home address ______________________________________________
__________________________________________________________
__________________________________________________________
Home tel#___________________________________________________
Home
email__________________________________________________
Work title___________________________________________________
Work location
________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Work tel#__________________________________________________
Work email_________________________________________________
interests ___________________________________________________
__________________________________________________________
__________________________________________________________
How
can you help out?_________________________________________
Would you be willing to work on
the our annual conference? _____________
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HOMEPAGE |
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