2011-2012 APPLICATION FOR COLLEGIATE MEMBERSHIPMENC AND STATE MUSIC EDUCATORS ASSOCIATIONMEMBERSHIP TERM:
JULY 1, 2011–JUNE 30, 2012
Membership I.D. # ______________________________
2. Indicate Preferred Mailing Address:
Name: _______________________________________ Street: _______________________________________
(I using school box #, street address must be included.)
City: ________________________________________State: ___________________Zip: ________________Country (outside U.S. only): ______________________Phone (including area code): _____________________E-mail: _______________________________________
(Email address is required to access online benefts.)
MENC periodicals are mailed second-class and arenot orwarded by USPS. Please notiy MENC immediately(firstname.lastname@example.org) o mailing and email address changesto ensure receipt o publications.
3. Indicate College/University:
_____________Collegiate Chapter # (i known): ____________________ School Name: _________________________________School City: ___________________________________School State: __________________________________(Determines state ailiation.)
4. Indicate Expected Graduation Date:
Month/Year: _______ / ________
5. Collegiate Membership Dues*
PLEASE SEE REVERSE SIDE FOR COLLEGIATE DUES SCHEDULE
Membership dues are non-refundable and are not taxdeductible as charitable contributions.
Society or Research in MusicEducation $37.00 $ _____
(includes subscription to Journal of Researchin Music Education)
MENC membership is a prerequisite.
Tax deductible contribution toFAME (see back or details) tosupport (select one): $ ______
Music in Our Schools Month
Teacher Recruitment and Retention
Wherever it’s needed most!
7. Membership Payment Options:
Visit MENC online: www.menc.org
Contact MENC Member Services:TELEPHONE: 1.800.828.0229; 703.860.4000
Return orm with payment to:MENC Collegiate Membership1806 Robert Fulton DriveReston, VA 20191 USA
Make checks payable to MENC (US currency only) or usecredit card (below). Please do not send cash.Please charge my (check one)
DiscoverName on credit card: ________________________________________________________________________________Credit Card No. _____________________________________________Exp. Date: ______________________________Signature