MEMBERSHIP FORM

Please us this form if you are not already a member of SWMDAMT

Pre-service Students and First Year Teachers---------NO charge

For all Others the dues are:---------$15.00

NAME__________________________________________________

____ I agree to include my name as a member on the SWMDAMT web site.

STREET________________________________________________

CITY_____________________STATE________ZIP____________

PHONE_________________________________________________

E-MAIL ADDRESS_______________________________________

------ I agree to include my email on the SWMDAMT web site.

SCHOOL________________________________________________

------ I agree to include my school on the SWMDAMT web site.

PROFESSIONAL ADDRESS_______________________________

POSITION______________________________________________

[ ] Pre-service [ ] Elementary [ ] Middle [ ] Secondary [ ] Post-Secondary

Please print, fill out and send with dues to: Elmeree Marlin, Treasurer
P.O. Box 556
Marshfield, MO 65706

Or, you may email the form to swmdamt@gmail.com first and pay dues at the next meeting.