National and State Affiliate Membership Form

* Indicates required field

*	Name:
*	Address:
*	City:
*	State:
*	Zip:
*	Phone:
*	E-Mail:

	School Name:
	Address:
	City:
	State:
	Zip:
	County:

	Member of:	NEA AFT Independent
	Union Office Held:

	I am a:	Annual dues: $35 Educator/Other $15 College Student /Retired Educator

*	Membership Status:

	Additional Contribution:	to be earmarked as: National State Affiliate Other

		Be advised that Teachers Saving Children^® does NOT release any information to individuals or organizations. Occasionally, however , we have members that would like to contact fellow local Teachers Saving Children^® members. If you DO NOT want you name , address, or phone number released for this purpose, please indicate below.
*		Release my info:

		I would like to be actively involved in a Teachers Saving Children^® Affiliate State Chapter.

*	Verification Check:	Type the characters that you see in this picture. Characters are not case-sensitive.

When finished please click the Submit button.