MCSS MEMBERSHIP FORM

Name______________________________ Home Phone______________________

Address____________________________________________________________

City_________________________ State_____ Zip Code + 4____________

School__________________________________ Phone_____________________

Address____________________________________________________________

City_________________________ State_____ Zip Code_________________

E-Mail______________________________ Direct mail to __Home __School

Level: __Elem. __MS/JH __H S __K-12 __ Col./Univ. __Business

Position: ___Teacher ___Dept. Chair ___Supervisor/Coord/Director

___Asst. Prin./Prin. ___Teach. Prep-Elem ___Teach. Prep-Secon.

__Publisher __Educational Consultant

Interest Areas: ____Anth/Psych/Soc. ___Economics ___Geography

___Global Studies ___ Government ___History

                     MEMBERSHIPS

MCSS REGULAR MEMBERSHIP (Includes subscription to MCSS Newsline and reduced fees at MCSS Programs and the Northeast Regional Conference on the Social Studies)

_____New or _____Renewal… 25.00; Two years….$40.00…$________

Student/Retired Membership (same benefits)…$15.00……..________

Instructor’s signature required for students_______________________

LOCAL COUNCIL MEMBERSHIPS:
Cape and Islands…………..Free……………….$________
Central Massachusetts……….$5.00………………________
Greater Boston……………..$5.00………………________
Merrimack Valley……………$5.00………………________
Southeast Mass……………..$5.00………………________
South Shore……………….$10.00………………________
Western Mass……………….$5.00………………________

TOTAL ENCLOSED (Make check payable to MCSS)……………$________

Send to: Janna Bremer, 87 North St., Foxboro, MA 02035