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 _______
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)
____ $5 for Student NEA Members or Retired NEA Members (have voting privileges)
$________ Additional amount for any voluntary donations.
$ _______ 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
The caucus does not participate in Paypal at this time. Sorry for any inconvenience.
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.