School Science and Mathematics Association

Application for Membership

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Please complete the following form, print it out, and mail to the address shown below. At the present time, our program does not support web submission. 

School Science and Mathematics Association (SSMA) Membership (2006-2007)

This form cannot be submitted online or by email at this time. You may also download the file and send it to Julie Thomas or Sandi Cooper by mail.
 

Name: ___________________________________ E-Mail: _____________________________  Date: ________________

Affiliation—School/Department: __________________________________________________________________________________

Affiliation Street Address: ________________________________________________________________________________________

City: _______________________________ State: ____________  Zip Code:  __________ Country: ___________________

Affiliation Telephone #:  __________________________________   Fax #: __________________________________

Home Street Address:  __________________________________________________________________________________________

City: __________________________ State: _________________ Zip: _____________

Home Telephone #:  __________________________________           

Preferred Mailing Address:                     [    ]                Affiliation                OR                            [    ]                Home

Area(s) of Expertise:     (Please check all that apply.)

Grade Level(s):     (Please check all that apply to your students or to your pre-service/in-service teachers.)

MEMBERSHIP RATES:   (Please check one.)

 [    ] Active …… $50.00/year                                              [    ] Active International ……… $60.00/year

 [    ] Student ….. $25.00/year                                             [    ] Student International ……. $30.00/year  

 [    ] Emeritus….. $25.00/year                                             [    ] Life …. $0.00/year

(Please check one.)    [    ] Membership Renewal                                   [    ] New Member

X: __________________________________________________________________

             Signature of Faculty Instructor or Advisor (Students Only)

Check, money order, or cash in US$ payable to SSMA

Mail to:     School Science and Mathematics Association
                c/o Julie Thomas and Sandi Cooper, Co-Executive Directors
                Oklahoma State University
                245 Willard
                Stillwater, Oklahoma 74078

This form cannot be submitted online or by email. You may also download the file and send it to Julie Thomas or Sandi Cooper by mail.
SSMA Membership Form (MS Word | PDF)