Three Rivers TESOL: Membership/Directory Form
Join Three Rivers TESOL for the current membership year!

Members please fill out the form to update your information for our database.

Membership year:  _______________________

Application date: _______________________________________

Membership year will be from Fall Conference to beginning of Fall Conference the following year.

MEMBERSHIP DUES (Circle one): Individual $30
  New/Renewal? Student $15
    Note: Students must submit a photocopy of their student identification card.



 

Are you a member of International TESOL? ____ yes ____ no



A mailed receipt of payment will be made only upon request.

Please print out this form, fill it out, and send to:

Peter Kolenich
English Language Institute
University of Pittsburgh
2816 Cathedral of Learning
Pittsburgh, PA 15260

NAME: _______________________________________________________________________
ADDRESS: _______________________________________________________________________
  _______________________________________________________________________
PHONE (wk): ________________________________________ FAX: ___________________________
PHONE (hm): ________________________________________ EMAIL: ________________________

The newsletter will be mailed electronically.

Special Interest Groups (circle one/two):

K-12 Program Administration Research
Higher Education Professional Development Adult ESL

Current Assignment (circle all that apply):

Administrator Full-Time ESL Teacher Student
Methods Instructor Part-Time ESL Teacher Other (explain)

Ideas for future meetings? ________________________________________________________________________________

____________________________________________________________________________________________________