Online Membership Application Form Membership Type —Please choose an option—CurrentNewRenewal of Expired Membership First Name Last Name Street City State Zip Work Phone School District Personal Email Address School Email Address Primary Area of Interest —Please choose an option—Health - HPhysical Education - PDance - DAPE (Adapted Physical Education)General - G Teaching Level —Please choose an option—E - ElementaryM - MiddleS - SecondaryU - University/CollegeO - Other Students Only - What school do you attend? Students Only - What year are you in school? —Please choose an option—FreshmanSophomoreJuniorSeniorGraduate Which district are you in? —Please choose an option—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? —Please choose an option—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