Name (please print) ________________________________________________________________

Address ________________________________________________

_______________________________________________________ Postal Code _______________

Alberta Teacher Certificate No _____________________________________

School or Employer _____________________________________________

ATA Local Name and No. ________________________________________

Category of ATA Membership (check)

 _____Active  ____Associate ____ Life____ Honorary ____

GTEC Membership (check) ____ new  ____ renewal 

____ Regular $25.00  ____ Student $ 5.00   ____Subscription $40.00

Regular – ATA member, entitled to full privileges, including right to vote and hold office.

Student – student member of ATA, entitled to all benefits and services except the right to hold office.

Affiliate – not ATA member, may not hold office or vote.

Subscription – GTEC publications shall be available to interested organizations at an annual rate.

Make cheque payable to the Alberta Teachers’ Association and forward to: