SPEECH COMMUNICATION ASSOCIATION

OF SOUTH DAKOTA

Name __________________________________________________________________
First Last Initial

School _________________________________ Phone__________________________

School Address__________________________________________________________

City ___________________________________________ Zip Code _______________

Home Address ________________________________ Phone ____________________

City ___________________________________________ Zip Code _______________

E-Mail Address __________________________________________________________

New Faculty __________ Renewal __________

Number of years teaching/coaching as of May of this year _________

Will you be attending the banquet? ___Yes ___No