JTAT MEMBERSHIP RENEWAL FORM

Your Name _________________________________

Home Address ___________________________________________________________

City ____________________________, State _____________________ ZIP_________

Home Phone ____________________ Home Fax_____________________

E-mail Address ____________________________

School _________________________

School Address __________________________________________________________

City ____________________________, State _____________________ ZIP_________

School Phone ______________________________ School Fax _________________

School E-mail ____________________________

What kind of workshop do you want to attend?

What do you want to do as a volunteer for JTAT?