your welcome to join AIEA today
AIEA Membership Application
"Collaborating to strengthen Indian Education"
The Arizona Indian Education Association is a 501(c)(3) non-profit corporation.
Annual Membership Period: August 1, 2007 – July 31, 2008
Please check:New Member ______ Renewal _______
Notify by Email ______ or Mail ______
Make check/money order payable to AIEA
Mail to AIEA P.O. Box 13402, Phoenix, AZ 85002
MEMBERSHIP TYPE (check one please):
Private Corporation or Business $100.00 annual dues, entitled to two (2) votes maximum
Local Educational Agency (LEA) $50.00 annual dues, entitled to two (2) votes maximum
Tribal Education Program (TEP) $50.00 annual dues, entitled to two (2) votes maximum
Other Educational Agency (OEA) $50.00 annual dues, entitled to two (2) votes maximum
Individual Membership $25.00 annual dues, entitled to one (1) vote maximum
PRIVATE CORPORATION OR BUSINESS, LEA, TEP, OEA MEMBERSHIP
Name of Organization and/or Tribe: ________________________________________________________
Primary Contact Name: __________________________ E-Mail Address: _________________________
Mailing Address: ________________________________________________________________________
City: _____________________________ State: ______ Zip: _______ Phone: ___________________
Designated Voter Representatives
1. Name: ___________________________________________________
2. Name: ___________________________________________________
INDIVIDUAL MEMBERSHIP
Name: ________________________________ Tribal Affiliation: __________________________________
Mailing Address: ______________________________________________________________
City: ___________________________________ State: ______ Zip: _________ Phone: _______________
Home Address: ____________________________City: __________________ State: ____ Zip: ________
E-Mail Address: _______________________________________________ Phone: _________________
FOR OFFICIAL USE ONLY:
PAID: CHECK # _______ CASH ______PURCHASE ORDER #_____________
