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GETEA Membership Form 2012

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					                                                                            2012 Membership Form

 Personal Information
 Name: __________________________________________________________________________________________________
 Address: _________________________________________________________________________________________________
 City: __________________________________________________________State: ________________ Zip: _________________
 Phone: _____________________________________________ Fax: _________________________________________________
 Email: ___________________________________________________________________________________________________
 Work Information –             ___ Same School or ___ Relocated _____ Years Teaching Engineering & Technology
 School: __________________________________________________________________________________________________
 Address: _________________________________________________________________________________________________
 City: __________________________________________________________State: ________________ Zip: _________________
 Phone: _____________________________________________ Fax: ________________________________________________
 Lab Phone: _________________________________________ Lab Fax: _____________________________________________
 Email: ___________________________________________________________________________________________________
 School System: ____________________________________ GETEA Area: ___________________________________________

             Membership Dues (September 1, 2011 – August 31, 2012)
             Professional Member Dues                                                                         $35.00
             3 Year Profession Dues                                                                          $100.00
             1st Year Teacher or New to Georgia Teacher                                                       $15.00
             Retired Teacher or Undergraduate Student Membership                                               $5.00
             Thank you for supporting Technology Education in Georgia!                                        TOTAL

         Area 1                        Area 5                       Area 9                       Area 12                   Area 15
   Bartow, Catoosa,            Banks, Barrow, Clarke,       Baldwin, Butts, Jasper,    Bibb, Bleckley, Crawford,       Ben Hill, Crisp,
  Chattooga, Cherokee,            Elbert, Franklin,         Jones, Lamar, Monroe,      Dooly, Houston, Laurens,     Dodge, Irwin Telfair,
  Dade, Floyd, Gilmer,         Greene, Hart, Jackson,      Pike, Putnam, Spalding,      Peach, Pulaski, , Twiggs,   Tift, Turner, Wheeler,
Gordon, Murray, Pickens,         Madison, Oconee,                    Upson                      Wilkinson               Wilcox, Worth
   Walker, Whitfield            Oglethorpe, Stephens                Area 10                      Area 13                   Area 16
         Area 2                        Area 6             Burke, Columbia, Glascock,    Bryan, Bulloch, Candler,     Appling, Atkinson,
Dawson, Fannin, Forsyth         Atlanta City, Carroll,       Hancock, Jefferson,          Chatham, Effingham,          Bacon, Berrien,
   Habersham, Hall,            Coweta, Fayette, Fulton         Johnson, Lincoln,       Emanuel, Evans, Jenkins,      Brantley, Camden,
Lumpkin, Rabun, Towns,         (South of I-20), Harris,      McDuffie, Richmond,        Liberty, Long, McIntosh,      Charlton, Clinch,
      Union, White               Heard, Meriwether,           Taliaferro Warren,         Montgomery, Screven,          Coffee, Echols,
         Area 3                    Talbot, Troup             Washington, Wilkes        Tattnall, Toombs, Treutlen     Glynn, Jeff Davis,
 Cobb, Douglas, Fulton                 Area 7                       Area 11                      Area 14              Lanier, Lowndes,
(North of I-20), Haralson,             Dekalb             Chattahoochee, Lee, Macon,    Baker, Brooks, Calhoun,     Pierce, Ware, Wayne
     Paulding, Polk                    Area 8                 Marion, Muscogee,           Clay, Colquitt, Cook,
         Area 4                   Clayton, Henry,         Quitman Randolph, Schley,    Decatur, Dougherty, Early,
        Gwinnett                  Morgan, Newton,          Stewart, Sumter, Taylor,     Grady, Miller, Mitchell,
                                 Rockdale, Walton               Terrell, Webster           Seminole, Thomas

 Make checks payable to:
                                                                             If you are a new member or have not been a
 GETEA Treasurer – Pam Brown                                                 member for the past 3 year - did someone get
                                                                                     you to join or re-join GETEA?
 Mail Payment to:            Pam Brown
                             GETEA Treasurer                                                     Referred By:
                             P.O. Box 1099
                             Newnan, GA 30264



                                                                                                                                     E-2012

				
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