MESTA Membership Form

Please print this page and mail the completed form along with a check (payable to MESTA) to:

Amanda Pata

20679 Country Club Dr.

Harper Woods, MI  48225

Name: ___________________________________________________

Address: _________________________________________________

Address 2: ________________________________________________

City: ____________________________________________________

State: ________________________  Zip Code: __________________

Telephone number _________________________________________

Email address _____________________________________________

Please check the appropriate membership:

Regular membership:  _______ 1 year ($10)  _______ 3 years ($25)

Family membership:   _______ 1 year ($15)  _______ 3 years ($35)

Student membership:  _______ 1 year ($5)

Lifetime membership: _______  (fill-in fee based on Life Member fee schedule)

Are you currently a MESTA member?  __ Yes  __ No

NOTE:  The membership year runs from July 1 – June 30.  Memberships expire on June 30 of the membership year.

Are you doing your Student Teaching or Interim Teaching this year?  __ Yes  __ No

(MESTA provides free membership for 1 year only, during the year of student/interim teaching)

School District (or University, or none): __________________________________________

School Building (or University Department, or none): _______________________________

Grade Level Taught: __ Elementary  __ Middle  __ High  __ College  __ Other

Course Name(s) Commonly Taught: ______________________________________

Thank you for joining MESTA!

Membership forms and checks should be sent to: Amanda Pata, 20679 Country Club Dr., Harper Woods, MI  48225.  Inquiries about membership status and changes in your member profile should be sent directly to: Eric Kennedy (ekennedy3120@charter.net)