DCMEA Membership Form
Current, Retired, and Private Teacher Membership Form: 2018-2019, renewed annually
First Name *
Your answer
Last Name *
Your answer
Email for DCMEA Newsletter and information: *
Your answer
Home Address Line 1 *
Street Name
Your answer
Home Address Line 2 *
City, State, Zip
Your answer
Home Phone *
Ex: (area code) 555-5555
Your answer
Home Email *
Your answer
School District (please choose one):
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, 2018
Forms received after this date cannot be guaranteed to be listed in the 2018-2019 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

Submit
Never submit passwords through Google Forms.
This form was created inside of Wappingers Central School District. Report Abuse - Terms of Service