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AATI LI 2012 MEMBERSHIP APPLICATION

AATI LI dues are for the calendar year, from January 1, 2012 to December 31, 2012.

Lapsed or new members, sign up now for 2012 to receive important news and notices of events. Non-current members will be considered inactive and retired from our mailing list as of April 15th, 2012.

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Kindly print all information and

 return this completed from, with your check payable to AATI Long Island, to:

Maria Brofka,   114 Ellman Place, Syosset, New York 11791

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Name ____________________________________ School Name __________________________________

Home Address _____________________________  School Address________________________________

_________________________________________       ___________________________________________

Check:    ______ Elementary     ______   Middle/ Jr. High     ______ High School        ______ College

Home Phone _____________________________        School Phone __________________________

Home E-mail _____________________________       School E-mail __________________________

Please check one of the following:

______ Regular Membership: $25.00 (January 2012– December 2012)                                                                      

______ Retiree Membership: $20.00 (January 2012 – December 2012)                                                          

______ University Student Membership: Free (January 2012 – December 2012)                                 

My contribution to the Giovanna Morabito Memorial Scholarship fund:                          $ _______

                                                                                                            Total amount enclosed:          $ _______

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I would like to help with the following AATI-LI activities:

____ Scholarship Committee                            ____ Workshop presentation at an AATI LI meeting

____ Poetry Contest Committee                       ____ Hospitality (Distribution of materials at AATI LI events)

____ CSJ-AATI LI Annual Breakfast  @ Hofstra         ____ Website Committee

____ Technology / Computer assistance                       ____ Other (specify) ______________________________

To help us address your professional needs, please indicate the topics that interest you:

_____Technology     _____AP               _____ Music     _____ Culture

_____Listening        _____Speaking     _____Reading   _____Writing

Other: _________________________________