MATE Membership Application
(please print)

Name: _____________________________________________

Dr. ____ Mrs._____ Ms. _____ Mr. _____

Position: __________________________________________

Institution: ________________________________________

Address:___________________________________________

___________________________________________
___________________________________________

Work Phone: ______________________________________

Home Phone: ______________________________________

Email ____________________________________________

Affiliation:
______ K-12 Educator
______ Community College
______ 4-year College/University
______ State Department of Education
______ Student College/University

(school _____________________________ )

______ Other _______________________________

Yearly Dues: $20 ($5 for students)
Send checks (payable to MATE) and completed form to:

Dr. Clarence Miller, MATE Treasurer
344 Wye Road
Baltimore, MD 21221