DCMEA Membership Form
Current, Retired, and Private Teacher Membership Form: 2019-2020, renewed annually
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Email *
First Name *
Last Name *
My information is the Same As Last Year (If "NO" please continue to fill out the rest of the form. If "YES" you are DONE!)
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Email for DCMEA Newsletter and information:
Home Address Line 1
Street Name, Apartment
Home Address Line 2
City, State, Zip
Home Phone
Ex: 555-555-5555
Home Email
School District (please choose one):
If you answered "Catholic or Other" for school district please list your school here.
School Building(s)
School Phone
Ex: (area code) 555-5555 *include ext. if applicable
School Email
Grade Levels Taught (Check all that apply)
Subjects Taught (Check all that apply)
Major Instrument/Voice
DCMEA Festival Participation (Check all that apply)
Would you like to be listed as a private teacher?
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If YES, list instrument(s)/voice that you teach privately:
Contact Phone for Private Teachers
Contact Email for Private Teachers
Would you like to be listed as an accompanist?
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Contact Phone for Accompanists
Contact Email for Accompanists
Would you like to be listed in the DCMEA Online Directory? (Restricted access area)
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Membership Fees (check one):
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MEMBERSHIP FORM AND MEMBERSHIP FEE DUE no later than: September 30th, 2019
Forms received after this date cannot be guaranteed to be listed in the 2019-2020 Directory

RETURN APPLICABLE DUES CHECK PAYABLE TO DCMEA TO:
Geralyn Ely, Treasurer  
19 Buttonwood Lane
Rhinebeck, NY 12572

Membership Form/Directory Questions:
Lisa Esposito, Membership Chair
lisa.esposito@wcsdny.org
A copy of your responses will be emailed to the address you provided.
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