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Membership/Renewal Form
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. You can then save the page and email the entire page to me or print it and send it to me via snail mail!
Please complete the following and mail it along with your check made out to ASTA to:
Patty
Brown
President
Alaska Science Teachers Association
PO Box 984
Haines, AK 99827
Today’s Date ___/___/___ [ ] Information Update [ ] Renewal [ ] New
Name _______________________________________________________________
Mailing Address _______________________________________________________
City ____________________________ State ______ Zip Code __________________
School _______________________________________________________________
Grade/Teaching Area ___________________________________________________
Home Phone ____ - ____ - _____ Work Phone _____ - ______ - ________
Email address ____________________________@___________________________
Newsletter - Please choose one of the following options:
email it to me [ ] U.S Post Office – mail it to me [ ]
Amount Enclosed:
[ ] Student $10.00 [ ] Retired $10.00
[ ] Regular $20.00 (1 year) [ ] Regular $30.00 (2 year)
[ ] Life $300.00
[ ] Mini-Grant Donation $ ______ [ ] ASTA Pin $ 5.00
[ ] ASTA T-Shirt $15.00 Sizes [ ]S [ ]M [ ]L [ ]XL [ ] 2XL
I am interested in assisting ASTA in the following way(s):
[ ] Board Member [ ] Teaching Classes [ ] District Representative
[ ] Public Relations [ ] Web Page Content [ ] Conferences
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