Organization Membership Form 2009-2 by nrk14057

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									                       AATE Organizational Membership Form
Organization: _________________________________________________________________
Primary Rep Name(1): __________________________________________________________
Mailing Address: ______________________________________________________________
City, State, Zip (Country)________________________________________________________
Main Phone: _______________________ Cell Phone: ________________________________
Website:___________________________ Email:_____________________________________
Company Description___________________________________________________________
____________________________________________________________________________
Billing Contact (if different from Primary Rep)
Name/Title:___________________________________________________________________
Email: ___________________________ Phone: ___________________________________

Additional Organizational Representatives:
(2) Name:________________________________ Title:______________________________
      Email: ________________________________ Phone: ___________________________

(3)   Name:________________________________ Title:______________________________
      Email: ________________________________ Phone: ___________________________

Other Affiliations (circle all that apply): ASSITEJ/USA EdTA ATHE Other: _____________
Affiliate State Organization: ________________________ Discount Code: _______________

Areas of Interest (select up to 3)
   Pre-K - 8th Grade                                        International
   High School                                              Applied Theatre (formerly TIE)
   College/University/Research                              Playwriting
   New Guard                                                Professional Development
   Youth Theatre                                            Museum Theatre
   Professional Theatre                                  Other Areas of Interest: _________________

Which AATE resources do you expect to be most useful to you?
  Publications                                         Job Listings
  Conference                                          Theatre In Our Schools Events
 Online resources                                     Other
  Email alerts                                    (specify):_______________________

How did you hear about AATE? __________________________________________________
____________________________________________________________________________________

PAYMENT INFORMATION                                           METHOD OF PAYMENT:
Organizational Membership Dues:             $ 220.00             Check    Mastercard     Visa
(Add $30 outside U.S.)                      $ ________        #__________________________________
Please accept my tax-deductible donation:   $ ________        Exp ___________ V-code ______________
TOTAL AMOUNT authorized                     $ ________


   Please return this completed form with payment to the AATE Office at the address below,
or if paying by Visa or Mastercard, you can email it to info@aate.com, or fax it to 240-235-7108
             AATE 7979 Old Georgetown Road, 10th Floor, Bethesda, MD 20814.

								
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