CoTESOL Membership Application

NAME: [last name]          [first name]
New Membership OR Renewal Membership
Today's Date:/ / (mm/dd/yy)
Mailing Address:       Apt.#
 
                      [City, State, ZIP code]
Home Phone: ()  
Work Phone: ()  
Fax:               ()  
E-mail:
Institutional Affiliation (school or employer):

POSITION:
Teacher/Instructor Professor Administrator
Materials Writer Support Staff Specialist (Media, Librarian, etc.)
Student Paraprofessional Other:

Special Interest Groups (SIGs)
Please specify your first and second choice as 1 and 2.
Adult Education
Applied Linguistics
Computer Assisted Language Learning
Higher Education / Intensive English Programs
Secondary Education
Elementary Education

Select Your Type of Membership:
Associate Level $20.00
Student/Volunteer - Paraprofessional
Professional Level $25.00
Teacher/Instructor/Professor/Administrator/etc.
Joint (two-member household) $ 35.00

Send to:
CoTESOL
c/o Larry R. Fisher
63 UCB
Boulder, CO. 80309-0063
Tel:(303) 735-4234	Fax:(303)492-5515
email: fisherl@Colorado.EDU