APPLICATION FOR MEMBERSHIP
Please print and mail the completed form to the address below.

Name

School/College

Address

City

State/Province

Zip

Country

Home Phone

School Phone

Teaching Status (check one): Current - Inactive - Retired -

School Address

Degrees

Certifications

Church Jurisdiction

Congregation

Subjects/Grades taught

Years of experience

E-mail

Print, complete, and mail this form with your check for $25 for annual membership or $250 for lifetime membership to:

Community of Christ Professional Teachers/Educators Association
201 Oak Hill Cluster
Independence, MO 64057