South Central New Mexico Association for the Gifted

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This form is the membership application form for the organization.

Demographic Information

First Name *

Last Name

Street Address *

City *

State *

Zip Code *

District/School *

Primary Phone (xxx.xxx.xxxx) *

Secondary Phone (xxx.xxx.xxxx) *

Alternate Email *

Are you *

Parent of a Gifted Student

Advocate of a Gifted Student

Educator

Gifted Student

Required

Membership dues of $20.00 can be sent to our treasurer at:

SCNMAG
P.O. Box 2513
Las Cruces, New Mexico 88004

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