Member Information Form 

Please print a copy of this personal and institutional information form. Use it also to nominate people to the Executive Board of WVTESOL. 

Return the form along with your dues for the coming membership year (April 2000 to April 2001) to:

Dara Shaw

WVU Intensive English Program

P. O. Box 6297

116 Eisland Hall

Morgantown, WV 26505-6927

Or fax it to (304) 293-8642.


 Personal Information


Home Address____________________


City, State Zip ____________________

Home phone _____________________

 Areas of Interest

(check only one)

________ K-12

________ Higher Education

________ Literacy and Adult Education



(Check here [ ] if you have already paid.)


_____Part-time or volunteer--$7.00

_____ Student--$7.00

Institutional Information


Job Title________________________

Work Address____________________


City, State, Zip____________________


e-mail address____________________

 Nominations for Executive Board

Please write in the name of the person you wish to nominate beside the appropriate office.

Vice President:


K-12 Representative:

Adult Education and Literacy Representative:

Higher Education Representative:

Member's signature_______________________________ Date:__________________