Kansas TESOL

Membership Application

Dues cover one calendar year from date of inscription
(Today's Date:________)

 Name: __________________________________________________

Address: _________________________________________________

City: _________________________  State: _____  Zip: __________

Position and School/Affiliation:

________________________________________________________

Work Phone: _______________ Home Phone: __________________ E-Mail Address:________________________________________

Please circle any of the above information that you do not want

included on our KATESOL/BE Membership List. 

Check One:  ____  New Member     ____  Renewal

Check One: __$15.00 individual dues   __ $7.00 student,                                                                             paraeducator or volunteer

Interest Section (check one or more)

____   Higher Ed      ____ Elementary      ____   Adult Ed       

 ____   Secondary    ____ Migrant Ed       ____   Applied Linguistics

____   Bilingual Ed    ____ CALL       ____   Other (____________)

Send to:

Debbie Taylor
6400 Longview
Shawnee, KS 66218