WASA Membership Application Form

2007-08 APPLICATION FOR

WASA ACTIVE MEMBERSHIP

For more information or if you have questions about WASA membership, contact Jamie Chylinski, jchylinski@wasa-oly.org.

Want to register as an associate, retired or student/intern member? Please use the print version. 297k [pdf]

The application is for a:

New active member Renewal/Change in member type

First Name

Last Name

Badge Name

Title

None Ed.D. Mr. Mrs. Ms. Ph.D.

Position/School

District

District No.

Business Address

City

State

Zip

County

Bus. Telephone

Bus. Fax

E-mail

Home Address

City

State

Zip

County

Home Telephone

Birth Date

Month

Day

Year

Please send mailings to my: Work Home

Component Group

Choose One:

	Business and Personnel Administrators (BPAC) Subgroup affiliation:
	Instructional Program Administrators (IPAC) Subgroup affiliation:
	Principals
	Special Education Administrators
	Superintendents
	Undecided

Active Member
Payment Schedule

The 2007-08 payment schedule is based on the member's
2006-07 salary X .75 of 1%.

2006-07 salary: $

AASA Membership

If you would like to join the American Association of School Administrators (AASA) at this time to renew your active membership, please check the appropriate box below.

	No. I do not wish to join or renew at this time.
	Yes! I want to join AASA as an active member.
	Yes! Please renew my active membership with AASA.

AASA's active membership fee of $387 includes full voting and office-holding rights. The AASA membership year is 12 months, starting with the month you become a member.

Purchase Order #

Please Invoice My District

I was encouraged to join by:

Please provide your email address and additional comments