PAC Membership Form 2005-2006

Membership Application

July 1, 2005 Invoice #200506

Annual Council Membership Dues Membership options-check one O 1 year = $ 190.00

O 2 years= $ 350.00

O 3 years= $ 530.00

In addition to covering standard overhead costs of managing a member association, parent advisory council membership dues provide an extensive member resource package, PAC training institutes, in-district workshops, lending library use, disability awareness resources, educator/appreciation awards program, discounts on publications, newsletter, bi-weekly e-news updates, access to the website and list serve. The PAC member package changes each year to provide new materials for an expanding resource library to benefit parents, families, students and staff.

Address institution purchase orders must be addressed to: MASSPAC ♦ PO Box 167 ♦ Sharon, MA 02067

Purchase orders or checks must be dated no later than October 31, 2005 for participation and voting rights at the annual meeting. Orders are still acceptable after this date.

Please mail purchase orders. Do not fax.

Credit card payments accepted via internet at www.paypal.com. Email recipient: info@masspac.org

Type of Application: _____New _____Renewal

Data required:

1). School District (specify if regional, charter or vocational)______________________________________________________

School District Address______________________________________________Superintendent______________________

Special Ed Director ___________________________________Phone___________________Website:_________________

2). Council Verification Data*

Parent Contact ___________________________________Title_________________________________

Address _________________________________Town/City___________________State/Zip _________

Phone _______________________Email _______________________________Fax________________

3). Member package shipping information:

Name_______________________________Shipping address:_______________________________________________

_________________________________________________________________________________________________