DCMEA Membership Form
Current, Retired, and Private Teacher Membership Form: 2019-2020, renewed annually
Email address *
First Name *
Your answer
Last Name *
Your answer
My information is the Same As Last Year (If "NO" please continue to fill out the rest of the form. If "YES" you are DONE!)
Email for DCMEA Newsletter and information:
Your answer
Home Address Line 1
Street Name, Apartment
Your answer
Home Address Line 2
City, State, Zip
Your answer
Home Phone
Ex: 555-555-5555
Your answer
Home Email
Your answer
School District (please choose one):
If you answered "Catholic or Other" for school district please list your school here.
Your answer
School Building(s)
Your answer
School Phone
Ex: (area code) 555-5555 *include ext. if applicable
Your answer
School Email
Your answer
Grade Levels Taught (Check all that apply)
Subjects Taught (Check all that apply)
Major Instrument/Voice
Your answer
DCMEA Festival Participation (Check all that apply)
Would you like to be listed as a private teacher?
If YES, list instrument(s)/voice that you teach privately:
Your answer
Contact Phone for Private Teachers
Your answer
Contact Email for Private Teachers
Your answer
Would you like to be listed as an accompanist?
Contact Phone for Accompanists
Your answer
Contact Email for Accompanists
Your answer
Would you like to be listed in the DCMEA Online Directory? (Restricted access area)
Membership Fees (check one):
MEMBERSHIP FORM AND MEMBERSHIP FEE DUE no later than: September 30th, 2019
Forms received after this date cannot be guaranteed to be listed in the 2019-2020 Directory

RETURN APPLICABLE DUES CHECK PAYABLE TO DCMEA TO:
Geralyn Ely, Treasurer
19 Buttonwood Lane
Rhinebeck, NY 12572

Membership Form/Directory Questions:
Lisa Esposito, Membership Chair
lisa.esposito@wcsdny.org
A copy of your responses will be emailed to the address you provided.
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