VACTE-SND Membership Application
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Name:___________________________________________
Home Address:
________________________________________________
______________________________________
School/Agency Name:
________________________________________________
Work Address:
________________________________________________ ________________________________________________
Home Phone:______________ Work Phone:______________ Cell:_____________Preferred E-mail:___________________
Membership Options
Select organizations you wish to join by writing amount in “Sent” column and totaling.
|
Organization |
Dues |
Sent |
|
VACTE-SND |
$10.00 |
|
|
VACTE-SND full-time student |
$3.00 |
|
|
VACTE |
$20.00 |
|
|
ACTE |
$60.00 |
|
|
Total:
|
Make checks payable to VACTE-SND and mail to:
Dr. Kari LaBell
Woodgrove High School
36811 Allder School Lane
Purcellville, VA 20180
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|
For Office Use Only: Paid (circle one): Check Cash Check # Date received: |