NCAE-NBCT Caucus Membership Form
Please fill out all of the required fields below.  
Please make checks payable to NCAE-NBCT Caucus:
Mail to:  Beverly Witherspoon
                658 Salem Springs Dr.
                Winston Salem, NC  27017

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First Name *
Last Name *
Home Address *
City *
Zip Code *
Email address *
Contact Number *
School System *
Membership Year *
Membership dues are $15.00 per membership year for NBCTs and $10.00 for non-NBCTs.  Membership year renews September 1st annually or when activated.
What is your certificate area? *
Have you had NBPTS Candidate Support Provider Training or NCAE  Candidate Centered Support Training? *
Are you a Candidate Support Provider? *
Have you had National  Board Certification Advocacy Training? *
Are you a Political Action Committee (PAC) supporter?
Do you cyberlobby?
I am a Public Education Activist
Please check all that apply.
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