NCESP State Affiliate Sponsorship Membership Form
Mailing Information For State Affiliate
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Name of State Affiliate
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Address
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City State Zip
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Phone FAX Number
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Email Address
Mailing Information for State Affiliate President
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Last Name First Name Middle Initial
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Address
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City State Zip
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Work Phone FAX Number Alternative Phone
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Email Address
SPONSORSHIP DUES
Platinum $500.00 0 votes
Gold $400.00 0 votes
Silver $300.00 0 votes
Bronze $200.00 0 votes
TYPE OF MEMBERSHIP
□ New State Affiliate Sponsorship
□ Renewing State Affiliate Sponsorship
PAYMENT ENCLOSED
□ Check $ ________ □ Other $ _________
All checks should be made payable to NCESP and mailed to:
NCESP
NEA Center for Governance
1201 Sixteenth Street, NW, Suite 813
Washington, DC 20036
Note: Only checks and money orders are acceptable payments through the mail. Please do not send cash.
If you have any questions or would like to request another type of membership form, please call the Center for Governance at 202-822-7173.
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NCESP State Affiliate Sponsorship Membership Receipt
(Receipt portion returned once payment and form have been received. Please keep a copy of this form for your records before mailing.)
Affiliate Name: ________________________________________
Amount Paid? $______________
Payment Type: □ Check (√ No. _______) □ Other __________
Membership Exp. ___________________
Received by: _________________________________
Date Received: ____/____/_____
National Council for Education Support Professionals
