WVSEA - Student Program

Student 
WVSEA/SNEA 2010-2011
1558 Quarrier Street
Charleston, WV 25311

Please print, complete and mail the registration form below with payment.

Name (last, first, m.i.): _______________________________________
Mailing Address: _______________________________________
City, State, Zip: _______________________________________
Phone: (_______) _______ - _____________
Social Security Number: ______ - ______ - ____________
College: _______________________________________
Year: Freshman
Sophmore
Junior
Senior
Graduate
55 00 00          000 000 0000

Position Code 16   Payment Method 1

Association Membership Code Annual Payment
SNEA 60 $15.00
WVSEA 60 $13.00
Local Chapter Dues 60 $___________
TOTAL: $___________

Charge my credit card:
Type of Card:
Account Number:
Expiration Date: /
Name on Card:

Signature: ______________________________

I understand that the total national dues, $4.60 is for a subscription for one year to NEA TODAY, including the special TODAY'S EDUCATION issue. NEA membership is open only to those who agree to subscribe to the goals and objectives of the Association and to abide by its Constitution and Bylaws.  WVSEA membership year runs August 1, 2010 to August 31, 2011.

Member's Signature ________________________________

Date: ____ / ____ / _____

EmailAddress: ________________________________________________

Retain a copy for your records.