UMTA Registration

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UMTA Membership Registration - 2010/2011

Instructions: To register for membership in UMTA, you must provide all the information below. Individual membership year begins July 1 and ends June 30. Your dues are calculated based on the time of year that you join and your membership class. Once dues are calculated, you will be given the opportunity to format your application for printing. You must print your application and send it with payment to the address on the application. For further questions, contact Sandra Preysz at membership@utahmta.org.

Enrollment Type
Membership Class
Name
Address	City: State: Zip:
Phone
Fax
E-Mail
Birthdate	Month: Day: Year:
Gender
Teaching Field(s)
Primary Teaching Situation	*At which institution
Education Level	Indicate the highest degree attained - or if applying for student membership, indicate the current year of study * if other then indicate:
Association	Indicate local association you are joining.
Info Change	Check this box if you have previously been a member and the info provided represents a change in Last Name, Address, or Phone