UCTE/LA On-line Membership Form
* Required
Last Name, First Name
*
Smith, Jane
Subject(s) Taught
*
*List all English/language arts-related courses.
Grade Level
Elementary
Middle School
Junior High
High School
College/University
School District
i.e. Jordan School District
School
i.e. Riverton High School
School Address
*
Street Address or P.O. Box
School Address (cont.)
*
City, State ZIP
School Telephone
including area code
School FAX
including area code
Home Address
Street Address or P.O. Box
Home Address (cont.)
City, State ZIP
Home Telephone
including area code
E-mail Address
*
i.e. janesmith@email.com
Comments or Special Instructions
Please indicate the type of membership you are signing up for:
*
New Member ($20)
Renewing Member ($20)
First-Year Teacher Member ($15)
Full-Time Student Member ($10)
Full-Time Student Membership Information
If you are applying for Full-Time Student Membership status, please complete the following additional information. For all other memberships, simply click "Submit".
Name of College/University
i.e. Utah State University
Number of Credit Hours Currently Taking
i.e. 12 credit hours
Chosen Course of Study (Major/Minor)
i.e. Secondary Education, English/Journalism