MAST MEMBERSHIP FORM

***Please print, complete, and mail to address below:

Type of Membership

______ 1 year $15.00

______ 3 year $40.00 ______ New ______ Renewal

______ Student $ 5.00’

Member Information

Name (Last, First) _________________________________________

Street Address ____________________________________________

City _______________________ State ________ Zip ____________

Local School System _______________________________________

School ___________________________________________________

Level ______ Pre-K ______ Student

______ Elementary ______ Supervisory

______ Middle/Jr. High ______ Organization

______ High School ______ Other ________________

______ College/University

Home Phone __________________ Work Phone ________________

E-mail Address ____________________________________________

Make check payable to the Maryland Association of Science Teachers or MAST and send with completed application and check to:

Maryland Association of Science Teachers
P.O. Box 368
Finksburg, MD  21048

_________________________________________________________________________

For Office Use:

Date Received _________ Received by ________ Amt Paid _______