PME Membership Enrollment Form

Membership Enrollment Form for Chapter Advisors

Required Fields Denoted *

Chapter Information

State * (e.g., Michigan)	Chapter * (e.g., alpha)	School *	Induction Date (e.g., 4/1/2011)

Advisor Name *	Advisor Email *	Phone Number *

Street Address *	City *	Zip *

Inductee Information

(Use TAB, not ENTER to move from one data field to the next.)

	First Name, M.I.	Last Name	Street Address	City	St	Zip	Email
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Number of Students Enrolled Above * ($20 each)
#Key Pins ($20)
#Honor Cords ($10)
#T-Shirts ($10)
#Sizes (#S,#M,#L,#XL)
#PME Constitutions ($1)
#Mathacrostics ($5)
#Chapter Rollbooks ($35)
#PME Banners ($50)
Rush Delivery? ($20) (Check if "yes")
Total:

Before submitting this form, check to make sure you have entered all inductee data correctly and make note of the total due. Upon hitting the submit button, you will be taken to a new page that provides payment information.