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MONTANA COUNCIL OF TEACHERS OF MATHEMATICS

MCTM Membership Form Please print this form, complete it and mail it (with an enclosed check, cash, or money order) to: Lisa Wood 2963 Spring Meadow Court Billings, MT 59102 Lisa Wood PERSONAL INFORMATION Name: ________________________________________         Address Change ______ Address: _______________________________________       New Membership _____ _______________________________________________       Renewal ____________ Phone: ________________ E-mail: _________________________________________ Elementary ____  Middle Grades ____  High School ____  College ____   Other _____________ MEMBERSHIP OPTIONS: ______ One year, Regular ($20) ______ One year, Student ($10) ______ Two years, Regular ($30) ______ Ten Year, Regular ($150) ______ Lifetime, Regular ($200) ______ Joint MCTM/MSTA membership ($40) ______ Retired (No Charge) Annual Dues Period: January 1 through December 31 Contribution to the Student Scholarship Fund: $ _____________