Long Island Physics Teachers Association Membership Form
First Name: Last Name:
Home Town: NY, Home Zip:
Home Phone (include area code):
Home Email Address:
Current Affiliation: Public HS Private HS College or University Other Retired
School District Name:
School Address: NY, School Zip:
School Phone (include area code):
School Email Address:
Send Snailmail from LIPTA to: Home School
Send me an Email when the LIPTA website is updated: Yes No
LIPTA membership cost is $15 for 1 year, $25 for 2 years, $50 for 4 years, and if RETIRED, $20 for 2 years, or $40 for 4 years.
Membership starts on the date your payment clears and runs for either 1, 2 or 4 years. If you renew BEFORE your membership expires, your membership will run from your current expiration date for one, two or four additional years.
Click "Submit" when done, and pay on the next page