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 Name__________________________ Home Address____________________ ______________________________ City, State Zip ____________________ Home phone _____________________  Areas of Interest (check only one) ________ K-12 ________ Higher Education ________ Literacy and Adult Education    Dues (Check here [ ] if you have already paid.) _____Professional--$10.00 _____Part-time or volunteer--$7.00 _____ Student--$7.00 Institutional Information Institution______________________ Job Title________________________ Work Address____________________ ______________________________ City, State, Zip____________________ Phone_________________________ 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: Treasurer: K-12 Representative: Adult Education and Literacy Representative: Higher Education Representative: Member's signature_______________________________ Date:__________________