2008 & 2009 WVSMA
MEMBERSHIP APPLICATION
Fill in the form and then click the print button
It is vitally important that you fill in all the boxes with complete and correct information.
Please do not assume that we have your information.
The WVSMA only accepts check for payment.
The WVSMA is not able to accept or process purchase orders.
Date:
High School:
Address:
City, State, Zip:
School Phone:
Training
Room Phone:
School Fax:
Instructor Information
Instructor's Name:
Instructor's email address:
Instructor's Name:
Instructor's email address:
Membership Dues. Check all that apply (and fill in all boxes) School Fee $85.00
Total Amount Due (Fill in this box.)
|
Which profession should receive credit for your membership? Certified Athletic Trainer (Certification # ) Vocational Teacher: (Endorsement: ) Regular Certification Teacher her: (Endorsement: ) Associate Retired |
Send completed application with appropriate amount to:
NEW ADDRESS:
Gary Clinton
WVSMA Treasurer
c/o Moses Lake High School
803 E. Sharon Ave.
Moses Lake, WA. 98837
Membership dues need to be paid by November 1, 2008 to receive full credit
This form is not sent over the internet. You have to print it out and send it in with your check.
