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:               ()  
Institutional Affiliation (school or employer):

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 (AE)
Content Area (CA)
Higher Education / Intensive English Programs (IEP/HE)
Secondary Education (SE)
Elementary Education (EE)
Teacher Education / Action Research (TE/AR)

Select Your Type of Membership:
Associate Level
Student/Volunteer - Paraprofessional
Professional Level $25.00
Joint (two-member household) $ 35.00

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