中大西洋桃李中文教师学会                                   CLTA-Taoli-Mid-Atlantic
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Membership Application
1.  Last Name *
2.  First Name *
3.  中文姓名 (in Chinese Characters) *
4.  Email Address *
5. Preferred Phone Number *
6.  Mailing Address (including City, State, zip code)
7. Membership Type *
8.  School / Institution / Organization *
9. City (of School/Institution/Organization) *
10. State (of School/Institution/Organization) *
11.   Role / Title *
12. If you are a practicing educator, what level do you teach?
13.  Membership Payment Options *
Membership and Annual Fees:  Effective one year till the end of the month when you join (Example:  September 10, 2019 to September 30, 2020)
11.  What are the instructional/administrative challenges you face now?
Welcome new members! Thank you for your interest in joining the TAOLI-CLEMA.
Please contact us at taoli.clema@gmail.com if you have any questions.
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