ICTM > Membership > Application Form

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Please print this form, complete it, and mail to: Maureen Busta, ICTM Secretary 2382 Iowa Highway 24 New Hampton, IA 50659

ICTM Membership Application

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MEMBER NAME:

Home Address:

 City:                                                                                     State:                    Zip Code:

Phone:

Email:

AEA #:                                                          School Name:

School District:

MEMBERSHIP FEES:

_____Regular Membership ( 1 year - $20, 2 years - $38, 3 years - $50)
_____Student Membership ($5)
_____Retired Membership ($5) - (0$ if ICTM member for past 5 years)
_____Institutional Membership ($35)*

Donation $ _________ Please specify use: _____________________________

*Institutional membership for elementary schools

CHECK YOUR MAIN AREA OF INTEREST (only one):

_____Grades K-2	_____Grades 9-12	_____Library/Media
_____Grades 3-5	_____Post Secondary	_____Supervisor/Administrative
_____Grades 6-8	_____Special Education