Membership Form

Caucuses are required to have at least 25 members and are now required to submit a list of its members and their signatures to the NEA. Please print, complete, and submit the following form.

NEA Ex-Gay Educators’ Caucus Membership

I currently am an NEA member and would like to join the NEA Ex-Gay Educators’ Caucus for 2018-19.

__________________          ______________________

Printed Name                                            Signature

(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 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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