CONTACT
INFORMATION |
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First
Name: |
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Last
Name: |
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Middle
Initial: |
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Position/Title: |
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Institutional/Organizational
Affiliation: |
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Daytime
Phone: |
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Fax: |
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Email: |
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PREFERRED
MAILING ADDRESS |
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Address,
line 1: |
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Address,
line 2: |
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City: |
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State: |
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ZIP: |
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Country: |
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Referred
By: |
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Preferred
Chapter Affiliation (if any):
(refer to NAME website for chapter
list)
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Type
of Institution/Affiliation: |
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MEMBERSHIP
CATEGORY
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(Please
check one category, plus the electronic subscription to Multicultural
Perspectives, an official journal of the National Association for
Multicultural Education, if interested)
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Institutional
Memberships:
(operating budget > $25,000)
Lifetime
Memberships:
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DIVERSITY
DONATION |
(tax-deductible) |
I
am including an additional amount to support NAME scholarships and advocacy
efforts. |
$
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Mailing
Lists |
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NAME
has my permission to include my name on mailing lists. Mailing lists
are only provided to groups that support NAME's goals. |
Yes
No |
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