Arizona Technology in Education Alliance
"Learning and Teaching in a Digital World"

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Membership Application

Please print and mail this application,
with payment to:

AzTEA: PBM 292, 1739 E Broadway Ste 1,
Tempe, AZ 85282

Federal Tax ID Number: 86-0930211

Dues:		Employees of Educational & non-profit organizations (per year)	$25.00
For profit organizations: Please see "Corporate Partnership Opportunities" beginning at $300
Membership valid for 12 month from date of receipt.
Chapter Affiliation:	WestSide Chapter Southern Az Chapter Northern Az Chapter EastSide Chapter

Application Type:

New Renewal Change of Information

Name:
School/Organization:
District Name:	#:
Title/Position:

Address:

City:
State:	Zip:
Work Phone:	Ext.
Fax:
Pager:
Cellular Phone:
School/Org URL:
School/Org e-mail:
Release my business address to vendors: Yes No

Home Address:

City:
State:	Zip:
Home Phone:	Unlisted:
Home Fax:
Personal URL:
Personal e-mail:
Use home address for all correspondence: Yes No

Application date:
Comments:

Last update:06.08.2004