Membership Form Membership Form (New and Renewal)Renewing Members Please help us by completing the form in its entirety. Your current information enables us to better serve you with relevant programs, events and resources.Membership Type *NEW Family or Individual ($15 annual)NEW Educator ($5 annual)RENEWING Family or Individual ($15 annual)RENEWING Educator ($5 annual)Last Name *First Name *Mailing Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryEmail *Primary Phone *Is primary phone voice, text or both? *VoiceTextBothSecondary Phone Is secondary phone voice, text or both? VoiceTextBothIf you are an Educator, please complete the following: School Name Grade(s) Subject(s) If you are a Family or Individual, please complete the following: Child #1: School Child #1: Grade Child #2: School Child #2: Grade Child #3: School Child#3: Grade Child #4: School Child #4: Grade For additional children, please use the space below: Please let us know if you have any special skills (i.e., photography, editing, your occupation) that may benefit PAGE and that you would be willing to use to help with small tasks. Please let us know if you are interested in any of our PAGE committees or activities: You may check more than one.School AG RepresentativePrograms and EventsCommunications and MarketingGrant Writing or Gift SolicitationsAdvocacyNomination Committee for Board PositionsHelp with small tasksHow did you learn about us? *Please check all that apply.Current PAGE memberChild's SchoolInternet (e.g., online media or social media)PeachjarParent/Teacher BoosterNewspaperOther: Please specify in the space provided below.PLEASE READ BEFORE SUBMITTING THIS FORM Once you have verified and submitted your form by clicking below, you will be automatically directed to another page to make a secure payment of your non-tax-deductible membership dues using PayPal. Thank you! VerificationPlease enter any two digits *This box is for spam protection - <strong>please leave it blank</strong>:
