Gay NOLA "FunMap"
If you will not be paying online, please download and complete a membership form. C. Scott Miller, Treasurer NEA-GLBT Caucus 2321 East 4th Street, #C438 Santa Ana, CA 92706 First Name* Last Name* Address 1* Address 2 City* State* Postal Code* Phone* Email* Please indicate the NEA Region in which you reside. REGION* Mid-Atlantic Midwest Northeast Pacific Southeast West Please indicate race (optional): RACE American Indian Asian / Pacific Islander Black Hispanic Multi-Racial White Please indicate sexual orientation (optional): Sexual Orientation Bisexual Gay Lesbian Straight Allie Other: Please list Gender (optional): Gender Identification Female Male Transgender Membership Levels: Active $25 NEA Membership (including Staff & Life) - Full Voting Rights Active ESP $15 NEA Membership (including Staff & Life) - Full Voting Rights Associate $15 NEA-GLBTC supporter (need not be an NEA member): No Voting Rights Student $5 NEA student member. All rights of an Active member. Retired $5 NEA retired member. All rights of an Active member. Domestic Partners / Married $35 (both eligible for Active membership) Unified National /State Active $40 Must be eligible for active membership at the national and state level.(CA, OR, PA, and WA residents only) Pink Triangle ~$100 ~ Receives all benefits/rights associated with Active membership in addition to recognition in the Fall Caucus Newsletter and the GLBTC Annual Dinner Program. Labyrinth ~$200 ~ All of the above and you may place a business card size ad in two caucus newsletters. Rainbow ~$500 ~ All of the above and you may place a business card size ad in each of the four caucus newsletters. Ichabod Crane Society ~$1000 ~ All of the above and two tickets to this year’s dinner. Please print this FORM. You may then proceed to make an electronic payment OR mail a check to the Treasurer. C. Scott Miller, Treasurer NEA-GLBT Caucus 2321 East 4th Street, #C438 Santa Ana, CA 92706
If you will not be paying online, please download and complete a membership form.
C. Scott Miller, Treasurer NEA-GLBT Caucus 2321 East 4th Street, #C438 Santa Ana, CA 92706
Please print this FORM. You may then proceed to make an electronic payment OR mail a check to the Treasurer.
