Print out this application form and RETURN
WITH PAYMENT to:
New York City Arts in Education Roundtable, Times Square
Station,
PO Box 2094, New York, NY 10108-2094
_____________________________
NAME |
|
|
_____________________________
ORGANIZATION |
|
|
_____________________________
ADDRESS |
|
|
_____________________________
CITY |
_______ ____________
STATE ZIP |
_____________________________
PHONE |
___________________________
FAX |
_____________________________
EMAIL |
___________________________
ORGANIZATION WEBSITE |
Please check one that applies...
See description of membership dues and benefits on the Membership page.
_____ Full Organizational Member (please check one below)
Tier 1 ___ [$350] Tier
2 ___ [$300] Tier
3 ___ [$275]
Tier 4 ___ [$125] Tier 5 ____ [$75]
_____ Collaborating Organization [$100]
_____ Friend of the Roundtable [$60]
I am interested in the following committees of the NYC Arts
in Education Roundtable:
| ___Development |
___Conference |
___Membership |
| ___Research/Advocacy |
___Publications |
___Program |
| ___External Affairs |
|
|
Make checks payable to:
NYC AIE Roundtable
Times Square Station
P.O. Box 2094
New York, NY 10108-2094 |
Direct all inquiries to the Roundtable Coordinator
at
(212) 642-5979, ext. 2 or via |
|
