AAABSE Membership Application

Send Form to:
Austin Area Alliance of Black School Educators
AAABSE Membership Application
P.O. Box 16294 Austin, Texas, Texas 78761

Membership Status: New Renewal

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Last Name, First Name, Middle, Mr./Miss/Ms./Mrs./Dr.

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Position Title School/Agency

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Home Address, City, Zip

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Phone, E-mail Address

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Business Address, City, Zip, Phone

I would like my correspondence to be sent: Home Business

Type of Membership: Active Retired Student

Membership Fees:

Total Amount Attached: $_______ Check #_______ Payroll Deduction ____(Form required)
Please make checks payable: AAABSE
Commission (Select One):
Local / General Administrator Higher Education
Non-Certified Personnel Instruction/Instructional Support
Teacher Legislative (Policy Development)
District Administrator Parent
Retired Educator Other: ____________________________

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Signature of Member                                 Date

Return application and check to: Dr. Linelle Clark-Brown @ CAC or mail it to the address listed above.

“Saving the African American child with the belief that all children can learn”
Return Application and check to the address above.