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

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.