TMATYC Membership Application

Name________________________________________________________________________

School_______________________________________________________________________

Address______________________________________________________________________

        ______________________________________________________________

E-mail________________________________________________________________________

Phone________________________________________________________________________

Home Address______________________________________________________________________

        ______________________________________________________________

I prefer that correspondence be sent to my

          _____ home address         _____ school address

Membership fee:

          ______ $10.00 for 1 year

          ______ $20.00 for 2 years

          ______ $25.00 for 3 years

Please make check payable to TMATYC and mail to

          Jim Zimmer
          Chattagnooga State Technical Community College
          4501 Amnicola Highway
          Chattanooga, TN. 37406-1097

TMATYC | AMATYC

This file was last modified on November 25, 2004. ©2003-2004 TMATYC.