Join Two-Year College English Association – Southeast   Membership Form

NAME:  Name is required.

COLLEGE:  College is required.

COLLEGE ADDRESS:  Address is required.

COLLEGE CITY:  City is required.    STATE:  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY State is required.    ZIP CODE:  Zip Code is required.

COLLEGE E-MAIL:  E-mail is required.    COLLEGE PHONE:  Phone Number is required.

HOME ADDRESS:  Address is required.

HOME CITY:  City is required.    STATE:  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY State is required.    ZIP CODE:  Zip Code is required.

HOME E-MAIL:  E-mail is required.    HOME PHONE:  Phone Number is required.

PREFERRED MAILING ADDRESS:  College Home Please select your preferred address.    MEMBERSHIP TYPE:  Regular - $30 Adjunct/Retired/Student - $10 Lifetime - $200 Please select a membership type.

PAYMENT METHOD:  Check Paypal Please select a method of payment.    MEMBERSHIP STATUS:  New Member Renewed Member Please select a membership type.

EMPLOYMENT STATUS:  Full-time Adjunct/Part-time Retired Graduate Student Please select a membership type.    CURRENT MEMBER OF NCTE?  Yes No Please select a response.

NOTE: To assist the Minority Involvement Representative in contacting members, please check the applicable item below:

RACE:  Caucasian African American Asian American Hispanic American Native American Other Please select a race.

COMMENTS: