Membership Registration
English Last Name *
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English First Name *
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Chinese Name (if there is one)
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Email Address *
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Preferred Phone Number *
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Mailing Address *
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Name(s) of School(s) or organization(s) where you are teaching
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Affiliated professional organization(s)
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Membership Type *
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Membership Fee *
Please make check payable to CLTA-WA and mail your payment to Jingran Wan, 25736 SE 34th ST, Sammamish, WA 98075
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Payment *
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Check number
If checked "By Check," please provide check number in the other box.
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Donations (optional): $
We appreciate any donation in excess of the dues amount!
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