Membership Registration
English Last Name *
English First Name *
Chinese Name (if there is one)
Email Address *
Preferred Phone Number *
Mailing Address *
Name(s) of School(s) or organization(s) where you are teaching
Affiliated professional organization(s)
Membership Type *
Required
Membership Fee *
Required
Payment *
Required
Check number
If checked "By Check," please provide check number in the other box.
Donations (optional): $
We appreciate any donation in excess of the dues amount!
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This form was created inside of Chinese Language Teachers Association Washington.