Name: ____________________________________________________

Mailing Address: ___________________________________________

_________________________________________________________

City: _________________________State: _____ZIP: ______________

Home Phone: (____) _________Work: (____) ___________

E-Mail ______________________________________________
(our primary means of communication)

School/Institution: ________________________________

County: ________________________________________

FACE Region: 1  2  3  4  5  6   Other_________    Check Region
(Other: Corporate= 7*, Institution=8*, Out of State=9*)
*non-voting member

Check one: _____ Renewal ______ New Member
 

Check here if you do not want your name included on a rented mailing list. Signature: ______________________________

Membership Categories: (check one)
______	Regular ($25.00)	______	Institution ($62.50) *
______	Full-time Student (Undergraduate-$12.50)	______	Corporate ($125.00)*

Cash___ Check#_____
Professional Status:
______	Teacher	______	Administrator
______	Media Specialist
______	Other ____________________________________

Educators Level:
______	Elementary	______	Senior High
______	Middle/Junior	______	Post-Secondary
	Other _____________________________________

Make checks payable to FACE and send to:

FACE State Membership
c/o Pauline Luther
1924 Seton Drive
Clearwater, FL 33763
e-mail: pauline_luther@places.pcsb.org