DISTRICT MEMBERSHIP APPLICATION

(Please print)
School District: ____________________________________________________________________
Name: Dr.,Mr.,Mrs.,Ms.,_______________________________________________________
Position: ____________________________________________________________________
Street Address: ____________________________________________________________________
City: ________________________________State:______________Zip:______________
County: ____________________________________________________________________
BOCES District: ____________________________________________________________________
Telephone: _______________________________________________Ext.:__________________
Fax: ____________________________________________________________________
Email (Email is required for communication): _______________________________________
 
Other District Users of NYSEDirectors.com:
_____________________________________________________________________________________
(Name)(Position)
(Phone)(Email)
_____________________________________________________________________________________
(Name)(Position)
(Phone)(Email)
_____________________________________________________________________________________
(Name)(Position)
(Phone)(Email)
_____________________________________________________________________________________
(Name)(Position)
(Phone)(Email)
 
 
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Signature: _____________________________________ Date: _____________________
Please complete the application and return by mail or FAX to the address or number below.
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