NAME Membership Registration

for assistance, contact membership@nameorg.org

CONTACT INFORMATION  
First Name:
Last Name:
Middle Initial:
Position/Title:
Institutional/Organizational Affiliation:
Daytime Phone:
Fax:
Email:
PREFERRED MAILING ADDRESS  
Address, line 1:
Address, line 2:
City:
State:
ZIP:
Country:
   
Referred By:
   
Preferred Chapter Affiliation (if any):
(refer to NAME website for chapter list)
   
Type of Institution/Affiliation:






   

MEMBERSHIP CATEGORY

 

(Please check one category, plus the electronic subscription to Multicultural Perspectives, an official journal of the National Association for Multicultural Education, if interested)

 



Institutional Memberships:




(operating budget > $25,000)

Lifetime Memberships:


   
   
DIVERSITY DONATION (tax-deductible)
I am including an additional amount to support NAME scholarships and advocacy efforts. $
   
Mailing Lists  
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