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Long Island Physics Teachers Association Membership Form

Member Information:

First Name:   Last Name:

Home Address:

Home Town:  NY, Home Zip: 

Home Phone (include area code):  

Home Email Address: 

School/Affiliation Information:

Current Affiliation:  Public HS Private HS College or University Other Retired

School Name: 

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

© 2017 Long Island Physics Teachers Association

Long Island Physics Teachers Association

a section of the American Association of Physics Teachers

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