Please us this form if you are not already a member of SWMDAMT

Pre-service Students and First Year Teachers---------NO charge

For all Others the dues are:---------$15.00 

         NAME__________________________________________________

            □  I agree to include my name as a member on the SWMDAMT web site.

          STREET________________________________________________

          CITY_____________________STATE________ZIP____________

          PHONE_________________________________________________

          E-MAIL ADDRESS_______________________________________

            □  I agree to include my e-mail on the SWMDAMT web site.

          SCHOOL________________________________________________

            □  I agree to include my school on the SWMDAMT web site.

          PROFESSIONAL ADDRESS_______________________________

          POSITION______________________________________________

          [  ]  Pre-service   [  ]  Elementary   [  ]  Middle   [  ]  Secondary   [  ]  Post-Secondary

        
          Please print, fill out and send with dues to:   Elmeree Marlin, Treasurer
                                                                                          P.O. Box 556
                                                                                          Marshfield, MO 75706