Name: __________________________________________________

Program/Institution name: ____________________________________

Mailing Address: __________________________________________

City, State, Zip+4: _________________________________________

Telephone (indicate home/work/cell): ___________________________

Email address: ____________________________________________

Membership category:
____ New member / ____ Renewing member
____ Intern/Student: $15/year

____ Basic: $20/year
____ Contributing: $35+/year
(includes 1 year subscription to Clearing Magazine - check here if you DO NOT want to receive Clearing ____)
____ Life: $200 (individual members only)
____ Institutional: $75/year (Organizations/programs only. Includes free job postings, listing on the California EE Providers pages, promotion of events on the Calendar, and quarterly newsletter (paper or electronic); does not includes one individual membership for the staff of the program)
Website for Institution: http://__________________________________

Section:
____ Northern
____ Southern

Mailing List:
____ check if you do not want to receive the newsletter 
____ Please send my newsletter electronically (you must list an email address above)
____ check if you do not want to receive a complimentary issue of Green Teacher Magazine
(a benefit for new AEOE members only - your address will not be sold or given out in any way - this is a one time only benefit we think you will like!)

Mail completed form and check (made out to "AEOE") to:

AEOE Membership Chair
Helen de la Maza,
8 Ardmore
Irvine CA 92602

Thank you for joining!