Download this document here (MS Word)
If you are NOT receiving the newsletter or renewal notices- please check with our treasurer (Leesa Wingo) to see if we have your correct email address!
Membership/Renewal Form
If you are a new member, welcome! If you are a regular, retired, or life
member, please update any information that may have changed.
Please print out, complete the following
and mail with your check to:
Leesa Wingo
Treasurer
Alaska Science Teachers Association
2831 Gillam Circle
Anchorage, AK 99517
Today’s Date ___/___/___ [ ] Information Update [
] Renewal [ ] New
Name_________________________________________________________________
Mailing Address________________________________________________________
City_______________________ State _________________
Zip Code ____________
School _______________________________________________________________
Grade/Teaching Area ___________________________________________________
Home Phone _____ - ______ - ______ Work
Phone ______ - ______ - _______
Internet email address ___________________@______________________________
Newsletter - Please choose
one of the following options:
email it to me [] U.S
Post Office - mail it to me []
Amount Enclosed:
[] Mini-Grant Donation $ ______ [] ASTA
Pin $ 5.00 [] Retired $10.00
[] Student $10.00 [] Regular $20.00 (1 year) [] Regular
$30.00 (2 year)
[] Life $200.00 [] ASTA T-Shirt $15.00
Sizes [] M [] L [] XL [] 2XL [] other
if available _______________
I am interested in assisting ASTA in the following way(s):
[] Board Member [] Teaching Classes[] District
Representative [] Public Relations
[] Web Page Content [] Conferences [] Contribute
to the Newsletter [] State-wide Conference
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