First Name:_____________________________  Last Name: ____________________________

Phone (areacode-phone number): ____________________________________________________

Current Email:__________________________________________________________________ 

Address: ______________________________________________________________________

City: ____________________________________________ Zip: _________________________

School: _______________________________________________________________________

What do you teach? ____________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Choose the Field you are in: ______ General Curriculum     ______ Physical Education

_____ Student Teacher    _____  Vocational Teacher    _____  Other

Choose the Local Organization in your area: _____  N/A  _____ Alamogordo   _____  Bloomfield

_____  Eunice     _____  Hobbs     ______ Hondo    _____  Las Cruces     _____  Ruidoso

_____  Tularosa

:  ____l Membership  $75.00

                           
                               

Please sign and date this application below:

________________________________________________     Date:______________________
Your Signature