NCEA Department of Boards and Councils
2013 Membership Registration Form
(For membership year January 1, 2013 - December 31, 2013)
(First-time memberships begin immediately and run through December 31, 2013.)
Sign up early and receive benefits for the rest of the current year free.
_______________________________________________________
Name of Board/Council/Commission
_______________________________________________________
Name of Institution
_______________________________________________________
Mailing Address
_______________________________________________________
City/State/Zip
(______) _______ - __________________
Daytime Phone
(______) _______ - __________________
Fax Number
_______________________________________________________
E-mail address
_______________________________________________________
Name of Chairperson
_______________________________________________________
(Arch)Diocese
_______________________________________________________
Person Responsible for Payment
_______________________________________________________
Mailing Address for Payment
_______________________________________________________
City/State/Zip
_______________________________________________________
Daytime Phone
Please check the type of board of education for your jurisdiction:
| ___ Single School, Parish, or Private Board | ___ Diocesan Board |
| ___ Regional Board (serving 2 or more schools) | ___ Individual Membership |
| ___ Religious Education Board | ___ Student Membership |
| ___ Total Education Board |
Total number of Board members: __________
Total annual Board membership fee: $ ___________ (See the chart below. Make check payable to NCEA.)
___ Bill the Institution
___ VISA ___ MasterCard ___Amex ___Discover Ex. Date ______/______
Card Number ____________________________________________
_______________________________________________________
Print Name Exactly as on Card
_______________________________________________________
Cardholder's Signature
Membership Fee
| School, Parish, Private, Religious Education, and Total Education Boards | |
|
10 or fewer members: |
$205 Yearly Group Membership |
| Regional Boards (2 or more schools served by one board) | |
|
10 or fewer members: |
$245 Yearly Group Membership |
| Diocesan Boards | |
|
10 or fewer members: |
$260 Yearly Group Membership |
| Individual Memberships | |
|
Individual Student: |
$85 |
Send the board roster containing the name, mailing address, and e-mail address of each board/council/commission member, along with this form and payment to:
Membership Office
National Catholic Educational Association
PO Box 63221
Charlotte, NC 28263-3221
Phone: (571) 257-0010. Fax: (703) 243-0025
To Index Page of Board Services