Southeast District of MASC

SOUTHEAST DISTRICT OF MASC MEMBERSHIP DUES 2011-12

This the official membership dues form for the Southeast District of the Missouri Association of Student Councils. Membership dues must be paid by October 15 to maintain membership status and be eligible to attend the district convention. Membership dues are $60. Schools who do not pay dues by October 15th will be considered Non-Members and be required to pay higher fees for the District Convention. If you have questions, please call: Jennifer Miller, 573-614-1030 or email: jmiller@dexter.k12.mo.us. Annual membership dues and convention registration may be paid with the same PO/check.

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USE THE TAB KEY OR CURSOR TO MOVE TO THE NEXT LINE OR SECTION! If you hit the "enter" or "return" key while completing this form, it will automatically submit the form before you are finished.
School Name: *
Type of School: *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
What county is your school located in? *
School Phone Number
*
School Fax Number *
Name of first advisor *
1st Advisor's Email *
1st Advisor's cell number *
2nd Advisor's name *
2nd Advisor's email *
School Purchase Order Number/Check Number *

Please put the Number of the Check/Purchase Order in this box. The District will invoice your school.
School's Accounts Payable Manager's Name *
Email address of Accounts Payable Manager. Note: Invoices will be emailed to the 1st advisor and to the School's Accounts Payable Manager. *
Do Not Fill This Out

Southeast District of MASC

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