MEMBERSHIP APPLICATION FORM
Please print out the application, fill it in, and mail it to us with your check
Please print all information
Member Name: _______________________________________________
Home Address: _______________________________________________
City: _________________________ State: ____________________ Zip: ____________________
Tel#: (______) ___________________________ E-mail Address: __________________________
Level Taught (Elem, JHS, HS, Coll): _____________________________
Job Description:
_______________________________________________________
(Classroom Teacher, Student Teacher, AP, Math Coord, etc....)
School Name: ___________________________________ District: ________________________
School Address: __________________________________________________________________
City: _________________________ State: ___________________ Zip: ____________________
Tel#: (______) _______________ School E-mail Address: ____________________
Check one: ______ 1 yr. $12 _______3 yr. $30
Make checks payable to ATMNYC and mail to:
Evelyn Estrine