Membership Application Form

October 1, 2007- September 30, 2008

New ______

Renew ______

Name: _______________________________________________________________

Occupation: ___________________________________________________________

Address: (circle one) Business Home ______________________________________

____________________________________________________________________

Phone: (work) ____________________________ (home) ______________________

E-mail: _________________________________________________________

To save money, we may go to an electronic version of the newsletter. Please indicate whether you prefer to receive the newsletter (circle one)
electronically by snail mail either method.

Please indicate if we may share the following information with other VCGE members:

Name ____ address ____ phone number ____ e-mail ____

If you are an educator, please list position / grades: ______________________________

Vermont NEA member: yes ____ no ____

Please indicate your interest in:

_____ Advocacy _____ Membership _____ Information services _____ Assisting with VCGE Events _____ Publication of VCGE newsletter

_____ Legislation _____ Organizing regional groups _____ Awards _____ Being a VCGE Director or Officer _____ Other

Dues are $20.00, individual; OR $30, family; OR
$10.00, student (with advisors signature _________________________________,
school name: _________________________________)

Please make checks payable to VCGE and mail along with this form to:

Vermont Council for Gifted Education, PO Box 154, Peacham, VT 05862

VCGE Home

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E-mail questions, comments, and suggestions for improvement to vcgeweb at vcge dot org
Last updated 16 October 2007