MCSS Membership Form

Print Form and send with remittance to:
Rebecca H. Berger, 147 Vienna Rd, New Sharon, ME 04955


Membership NEW or RENEWAL  -  $20 

Please PRINT

Name_____________________________________________________________________

 

Home Address______________________________________________________________

 

City_____________________________________State_______________Zip____________

 

School____________________________________________________________________

 

School Address_____________________________________________________________

 

City_____________________________________State_______________Zip____________

 

Home Phone______________________________School Phone_______________________

 

Email__________________________________________Snail Mail to: ___Home ___School

 

Level:    ___Elementary    ___Middle School    ___Junior High    ___High school    ___College
 
              ___K-12    ___Business    ___NA

 

Position:    ___Teacher    ___Department Chair    ___Supervisor / Coordinator / Director
 
                  ___Administrator        ___Teacher Prep - Elementary    ___Teacher Prep - Secondary

                  ___Publisher    ___Educational Consultant

 

Interest Area:    ___Anthropology    ___Economics    ___Geography    ___Global Studies

                         ___Government    ___History    ___Political Science    ___Psychology / Sociology

                         ___Social Studies