Membership Application

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Last Name	* required
First Name and Middle Initial	* required
Street Address	* required
Village/Town/City	* required
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Grade Level (Check all that apply)	Pre-Kindergarten Elementary Middle School/Junior High High School Educational Support Professional Higher Education Administration Retired Student NEA NEA Staff / Other
Region	Mid-Atlantic: DC DE KY MD IH NC VA WV Overseas Student NEA Midwestern: IA IN IL MI MN MO ND SD WI Northwestern: CT MA ME NH NJ NY PA RI VT Pacific: AK AL CA HI ID MT NV OR WA Southeastern: AL AR FL GA LA MS SC TN Western: AZ CO KS NE NM OK TX UT WY
Local/UniServ Name and Telephone Number
Membership Level	$20 Active (All Hispanics who are members of the NEA) $15 Associate (All non-Hispanics NEA Members and NEA Staff) $10 Student NEA members