Online Membership Application Form Membership Type ---CurrentNewRenewal of Expired Membership First Name Last Name Street City State Zip Work Phone Email Address Primary Area of Interest ---Health - HPhysical Education - PDance - DAPE (Adapted Physical Education)General - G Teaching Level ---E - ElementaryM - MiddleS - SecondaryU - University/CollegeO - Other Students Only - What school do you attend? Students Only - What year are you in school? ---FreshmanSophomoreJuniorSeniorGraduate Which district are you in? ---SE - Southeast District - CESA Districts 1 & 2SW - Southwest District - CESA Districts 3 & 4C - Central District - CESA Districts 5, 6, & 7NE - Northeast District - CESA Districts 8 & 9NW - Northwest District - CESA Districts 10. 11. & 12 Current district of employment? ---SE - Southeast District - CESA Districts 1 & 2SW - Southwest District - CESA Districts 3 & 4C - Central District - CESA Districts 5, 6, & 7NE - Northeast District - CESA Districts 8 & 9NW - Northwest District - CESA Districts 10. 11. & 12