Send to: NYS TESOL Teacher’s College, P.O. Box 185 525 W. 120th Street, Z-316 New York, NY 10027
Membership Form (effective 9/1/2011)
Renewal:
New Member:
First Name:
M.I.
Street Address:
City/State/Zip code:
Preferred Telephone:
Last Name:
Home
Work
Cell
Email:
(required to receive online newsletter)
Position:
Organization:
Special Interest Groups (SIGs): Please select your top 2 priorities from the interest groups listed below by marking a “1” and a “2” next to your top choices. 1st SIG. This is your primary interest group with NYS TESOL. You may hold office and vote in this SIG.
2nd SIG. You may receive information from this SIG.
A ESL in Adult Education
S ESL in Secondary Education
TE ESL Teacher Education
B ESL in Bilingual Education
H ESL in Higher Education
L Applied Linguistics
E ESL in Elementary Education
SE ESL in Special Education
T Teaching English Internationally
Region (check one) Buffalo
NYC
Capital District
Long Island
Hudson Valley
Rochester/Syracuse
Please omit my name from mailing lists provided to other organizations.
Membership Category (select one) Individual Member: (Note two-year savings!)
$40.00/yr
$70.00/2 yrs
Discounted Memberships (Please circle your category) Proof of Eligibility Required. Documentation requires completion of the Eligibility Webform and written confirmation as described below) Part-time / Adjunct (Documentation: A letter on your employer’s letterhead confirming that you do not have full-time employment.) $35.00/yr $20.00/yr
$60.00/2 yrs Retiree: (Documentation may vary. Please access Eligibility Webform to begin process.)
$20.00/yr Aide/TA/Para: (Documentation: A letter on your employer’s letterhead) $20.00/yr
Full-time Student (3-year limit) Documentation: Proof of full-time status in a degree-granting
If you are unable to provide the required documents, you have the option to pay the balance to subscribe as an Individual Member.
Please submit your documentation within 30 days. Access Eligibility Webform at: http://www.nystesol.org/membership/applicationform.html
Payment Information:
Check payable to NYS TESOL enclosed
Please write numbers clearly and sign: Please charge my: MasterCard
Discovery
VISA
Card #:
Exp. date:
Signature:
Office Use Only: Check Number:
Date:
New Expiration Date: