Fillable Contact Information Membership Application Texas Art Education Association

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Contact Information Membership Application Texas Art Education Association

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Revised11/21/18
Membership Application
Texas Art Education Association
14070 Proton Rd., Ste. 100, Dallas, TX 75244
Phone: 972/233-9107 x212; Fax: 972/490-4219
Email: info@taea.org
Contact Information
Name
Mailing Address
Home Phone Work Phone
Cell Phone Fax
Email Address
TAEA Membership Status (check one)
I will be a new member. Please add my information to the TAEA database.
I am a returning member. My TAEA number is:
School: District: TAEA Region*:
*(if known)
Professional Level (check one)
Elementary Private School Supervision/Administration
Middle School/Junior High Higher Education Museum
S
enior High
Retired Community Art
Student at , anticipating graduation in .
Membership Level (check one)
Active $55
For those engaged in the teaching of art or the
direction of art programs, or in the pursuits closely
related to the art education field.
Associate $44
First Year Professional. For those just beginning
their professional teaching career.
Retired $20
For those who are retired from the art education
profession.
Student $20
For full-time students who are not yet employed as
art educators.
Sustaining Membership $44
For conference exhibitors and businesses not
actively engaged in art education.
Institutional $275
For institutions directly or indirectly involved in art
education. Includes: ONE prepaid registration fee
for the TAEA annual conference and three
designated teachers’ participation in VASE/Youth
Art Month program – no substitutions can be
made.
List names of the three participating teachers,
including the one on this form. Attach separate
forms for each.
Name
Check which
one will attend
conference
___________________________________________________________________________________________________________________________
Payment Information: credit card information provided below check
Card Ty
pe:
Number:
Expiration:
Name as it appears on card:
Visa
MC
AmEx
Discover
3/4-digit
CVV2 Code
(back of
card):
Billing address:
Signature:
Dues
$
Memorial
Scholarship Fund
Donation*
$
Building Fund
Donation*
$
TOTAL PAYMENT
$
*Donorsof$50+mayspecifyatribute.
Checkone:
“Inhonorof” “Inmemoryof”
Honoree:
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Contact Information Membership Application Texas Art Education Association

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Completed 30 January 2021

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