MCTM Membership Form
For membership information see the Membership Flyer: http://www.mctm.org/MembershipFlyer.pdf
MCTM Membership
MCTM Foundation
I wish to make a tax-deductible contribution to the MCTM Foundation to support grants and scholarships for teachers (more info: http://mctm.org/foundation.php). If YES, fill in the amount in the Fees and Payments Section below.
Personal Information
First Name
Your answer
Last Name
Your answer
Street Address (Preferred)
Your answer
City, State, Zip (Preferred)
Your answer
School Name / Work Location
Your answer
School District Name, if known
Your answer
School District Number, if known
Your answer
Email Address
Please enter carefully - this email address will be the primary communication with you
Your answer
Alternate Email Address, if available
Your answer
Phone
Your answer
Alternate Phone
Your answer
Job Title
Required
Current grade level(s), check all that apply
Required
Region Map
In Which Region Do You Work (if known)
You can find your region on this pdf as well: http://mctm.org/schools.pdf
Fees and Payment
If registering as an E-Member, enter 0 under Membership Fee.
If registering as a Sustaining Member , enter 25 (or more) under Membership Fee.
Total Due is the sum of Membership Fee and Foundation Donation
Membership Fee
Your answer
Foundation Donation
Your answer
Total Due
Your answer
Payment Form
If choosing Credit Card, PLEASE NOTE: You will be prompted to pay via PayPal after this registration form has been submitted. The PayPal form will say "DONATION", but it IS your membership fee payment.
PO Numbers and Checks
If using a P.O., please send a copy either via surface mail or as an email attachment to mctm@mctm.org. Mail checks and P.O.s to: MCTM PO Box 130816 Roseville, MN 55113
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