FCRTA
Membership Form

2007-2008

Print and complete the following form:

Name:

Home Address:

City/State/Zip:

School:

Teaching Assignment:

Work Phone:

Home Phone:

FCPS Email Address:

Cluster:

I want the above information listed in the Membership Directory.
I only want my name, school, and email listed in the Membership Directory.
I am willing to help out with a committee for FCRTA.

___FALL CONFERENCE
___SERVICE PROJECT
___WEBSITE ENTRIES
___ MEMBERSHIP DRIVE
___ SCHOOL LIAISON
___ NOMINATIONS

Send the completed form
with a check for $10 payable to FCRTA
to Gail Kozak, Canterbury Woods Elementary.

Membership in FCRTA is open to all teachers and administrators in Fairfax County interested in reading instruction.

Click here to download a PRINTABLE MSWORD membership form.