2017-2018 VAJTA/JEA MEMBERSHIP FORM
Please fill out all of the information requested in this survey and send your check (made payable to VAJTA) to Erinn Harris, 501 N. Armistead Street, #102, Alexandria, VA 22312. Memberships will be processed upon receipt of your membership dues.
Last Name *
Your answer
First Name *
Your answer
Have you earned certified or master journalism educator status?
Click either that applies. If you have not, leave blank and proceed to the next question.
School Name *
Your answer
School Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
School phone number (include area code) *
Your answer
School FAX number (include area code) *
Your answer
County/School Jurisdiction *
Your answer
Your school email address *
Your answer
Home mailing address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home email address *
Your answer
What email address do you want to add to the listserv? *
Remember, that school addresses often won't accept attachments - you may want to choose an email address not associated with school for this purpose.
Check all media that you advise *
Required
Would you like a mentor? *
We will find an experienced or retired adviser in your area to help you out!
I would like to make an additional donation to the Student Press Law Center and have attached the following amount to my membership check
Check the membership option that you'd prefer. *
Joining both VAJTA and JEA brings back $5 to Virginia from the National Organization
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service