Membership Form

Caucuses are required to have at least 25 members and are now required to submit a list of its members to include: first name, middle initial, last name;  their NEA I.D. number (found on any NEA publication mailing label); and state. Please copy and email this information to:

NEA Ex-Gay Educators’ Caucus Membership

I currently am an NEA member and would like to join the NEA Ex-Gay Educators’ Caucus for 2021-22.  All information required by NEA.

__________________           ________________              _______

Print First, M.I., Last Name           Member I.D. Number               State

(The following portion of the form to be retained solely by the caucus for conducting caucus business.)

Name:  Last_________________________________  First________________________

Postal Address _____________________________________________

City ____________________________  State ____________  Zip _______

Email address___________________________________
Phone contact with area code______________________

Issues of interest:
Is there a particular type of volunteer work you are interested in:  (Check all that apply.)

____Public speaking/training     ____ Writing letters     ____ Fundraising

____ Research    ____CPA, accounting, budget   ____Lobbying

____ Distribute caucus brochures, etc. to inform NEA members of the caucus and its goals.

____ Host a caucus exhibit booth in your area

____ Grant writing   ____ Answering emails  ____ Website management

Other (Specify):  ________________________________________

Donations for caucus expenses (optional):

$ _______  Total amount enclosed

Make checks payable to Ex-Gay Educators’ Caucus  (not tax deductible)

Please mail form and payment to:

NEA Ex-Gay Educators’ Caucus
P.O. Box 543
Cottage Grove, MN  55016

If using PayPal: http://www.PayPal.Me/exgay

Please submit questions to

The views expressed in this document are those of the caucus. The caucus has no authority to speak for, or act on behalf of, the NEA.