Membership Form

Please Do not Begin Submitting 2012-13 Memberships until July 1st, 2012. This Form is still a draft.

Membership Form 2012-13 School Year
Please Note that this completely replaces the old mail in form.

Please fill out the form below. If you are retired, no further action is required. If you are an active member, please mail your $15 payment (put your name on the check) to
Craig Bebergal, CAF Treasurer
2846 Sun Valley Ct.
Tallahassee, FL 32303
Deadline is 10/31/12.
Confirmation of dues receipt will be sent by email.
Please email cbebergal@flvs.net with questions.

Name *

First

Last

School Name *

School City *

School County *

Phone Number-Primary *

-

Phone Number- Secondary *

-

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email -Primary *

Email- Secondary *

Choose Status *

Active (Currently Teaching Latin, Greek, or Hum) Associate (Former Teacher, Friend of Classics) Retired

Number of Years Teaching Latin in Florida, Including This Year *

Number of Years of CAF Membership, Including This Year *

Are You an FFLA Member This Year? *

Yes No

Does Your School Sponsor a JCL Chapter? *

Yes No

If You Do Sponsor a Chapter, What Level? (Check All that Apply) *

High School Middle School Elementary School

I will be including a donation to the Mama G (Marie Girardeau) Scholarship Fund *

Yes No

If You will be including a donation, how much will it be for? *

Have you Previously Been CAF Teacher of the Year *

Yes No

If You have previously Been Teacher of the Year, What Year? *

If You have Previously Held CAF or Forum Planning Offices, Please List to Assist in the Compilation of the History of CAF (Include Years if possible) *

Submit

Please Do not Begin Submitting 2012-13 Memberships until July 1st, 2012. This Form is still a draft.

Membership Form 2012-13 School YearPlease Note that this completely replaces the old mail in form.

Membership Form 2012-13 School Year
Please Note that this completely replaces the old mail in form.