Scribd
Upload
50 views1 page

Tesol PR Membership Form

This document is a membership form for Puerto Rico TESOL, an organization for teachers of English to speakers of other languages. The form allows current or new members to provide their contact information and select a membership level and payment method. Membership levels include regular, student, retired, and institutional rates ranging from $20 to $30 annually. Members also choose their local chapter and indicate their current level of work such as elementary education or administration.

Uploaded by

Gerardo E. Lopez Morales
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
50 views1 page

Tesol PR Membership Form

This document is a membership form for Puerto Rico TESOL, an organization for teachers of English to speakers of other languages. The form allows current or new members to provide their contact information and select a membership level and payment method. Membership levels include regular, student, retired, and institutional rates ranging from $20 to $30 annually. Members also choose their local chapter and indicate their current level of work such as elementary education or administration.

Uploaded by

Gerardo E. Lopez Morales
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Puerto Rico TESOL

Teachers of English to Speakers of Other Languages


website: puertoricotesol.org ~ emails: [email protected], [email protected]

REVISED MEMBERSHIP FORM


NEW
NAME: ________________________________________
Last (Names)

MAILING
ADDRESS

Country

HOME PHONE: _________________________


CELL PHONE: __________________________
E-MAIL: _____________________@________

Zip Code

Public

WORK/STUDY:

Private

_______________________________
_______________________________
_______________________________
City

Country

Zip Code

TELEPHONE(S): _______________________

MEMBERSHIP FEES (Please check the rate


that applies to you.)

Member ID # _______________

Middle Initial

_____________________________
_____________________________
_____________________________
City

PLACE:

First

RENEWAL

ONE YEAR

REGULAR

$25

FULL TIME STUDENT**

$20

RETIRED

$20

CURRENT LEVEL:
____ Elementary
____ Secondary
____ Higher Education
____ Administration
_____ Student
____ Other (please specify)

CHAPTER: (Check one)


____ CENTRAL
____ EASTERN
____ METRO
____ NORTHERN
____ SOUTHERN
____ WESTERN
PAYMENT:

INSTITUTION***

$30

* Special Group Rate Discount of $ 5 per person for 5 or more


new members from a given institution. Forms must be mailed
as one packet.
** Rate for full-time student only, undergraduate 12 credits or
more, graduate 6 credits or more. A copy of the present class
program is required with membership form.
*** This fee entitles institutions to mailings only.

_____ CHECK
_____ MONEY ORDER
_____ CASH (No cash through
the mail, please)

Referred by

MAIL TO:
MEMBERSHIP SECRETARY
PUERTO RICO TESOL
P. O. BOX 366828
SAN JUAN, PR 00936-6828

PLEASE DO NOT FILL OUT


Membership Card Date Sent:
______________________________
Check No. _____________
Date: _______________
Banking Institution: ______________

A $10.00 fee will be charged for each returned check.


Revised form 2014/jm

You might also like