2017-2018 BTANYS Membership Application
Membership in BTANYS runs from September 1 - August 31.

Please complete all information below.

If you have any questions regarding membership, email Nancy O'Connor at membership@btanys.org.

First Name *
Your answer
Last Name *
Your answer
School/College Name *
Your answer
School Email *
Your answer
Secondary Email
Your answer
Phone # *
Your answer
Address Line 1 *
Your answer
Address Line 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Affiliation *
Payment *
Membership Type - In order to receive discounted prices, ALL members of department must join. *
Required
If paying by check, enter check # below.
Your answer
If paying by purchase order, enter PO # below.
Your answer
Region *
Please let us know if you are interested in serving on the BTANYS Executive Board. Thank you for your consideration. *
If interested in serving on the BTANYS Executive Board, please give specific information below on the best way to reach you (email, cell phone, etc). Thank you for your interest.
Your answer
Thank you for joining BTANYS. We hope to meet you at various staff development events throughout the year. Please give suggestions below on how BTANYS can better serve you.
Your answer
STOP! If you are paying by credit card, make sure you click the link above to process payment before submitting this form. Thank you.
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