Membership

To become a member, print this page and fill it out completely. Mailing address is at the bottom.

Membership Form for the NEA Ex-Gay Educators’ Caucus

Name:  Last_________________________________  First________________________  MI _______________

Postal Address _____________________________________________

City ____________________________  State ____________  Zip _______

Email address___________________________________
Home phone with area code______________________
Cell phone 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):  ________________________________________

Dues category: (Check one)

____  $20 for Active voting membership (NEA members only, including Staff and Life)

____  $10 for Student NEA Members or Retired NEA Members (have voting privileges)

$ _______  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

Or pay using PayPal http://www.PayPal.Me/exgay Mail completed membership form to address above or email to admin@nea-exgay.org

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.

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