Student Membership Form

Personal Information:

Name:

Address:

Address:

City, ST Zip:

E-mail:

Home Phone:

School:

School Name:

Preferences:

Yes, print my contact information in the MTAG Directory. (Directory is distributed to members only.)

Yes, I would like to receive correspondence via e-mail.

Participation: I am interested in helping with the following committee(s):

Job Development

Government Relations

Reimbursement

Communications

Scholarship

Dues:

$10 Student Membership

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$10 Total