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Membership Application

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.................CONTACT INFORMATION/DEMOGRAPHICS
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     Please check:  [ X ] New

     Prefix     Mrs.

     First Name       Nada       Middle Initial       S

     Last (Family) Name   ABISAMRA

    University   Auburn University at Montgomery

     If providing home address, please use only the "Street Address" line.

     Street Address/PO Box  2600 Vaughn Lakes blvd. # 315

     City   Montgomery     Province/State    Alabama

     Country    USA        Postal/Zip Code   36117

This address will change on May 15, I will go back to Lebanon, my country for a month. My address will be:
Nada Salem AbiSamra
Officers' Bldg. # 2
MarTakla- Hazmieh
Lebanon

(I might stay in Lebanon and continue my Master's at The American University of Beirut where I studied for my Teaching Diploma in TEFL/TESL)

        Please include country and city codes for non-North American phone
        numbers so that we are more able to contact you. Please use
        abbreviations for state/province codes when available.

     Home phone  334-279-1394
                             In Lebanon: 011-961-5-453965
                                                   011-961-5-454346  (My parents')

     Primary E-mail  nadabs@hotmail.com

     Add'l E-mail   marcelcyn@hotmail.com

     Website http://meltingpot.fortunecity.com/zaire/131/homepage.htm
     Website http://nadabs.fly.to

     Date of Birth   June/21/1965  (to help us avoid duplicate records)

     TESOL Affiliate to which you belong, if any (i.e., MATESOL, etc.) ____________

     For the below questions, no response implies your consent.

     May TESOL send you e-mail regarding its products/services?  Yes
     May TESOL post or print your address, phone number, fax, and e-mail information
     in an on-line or printed membership directory?  Yes
     May we provide your name to other educational organizations
        or companies?  Yes

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.................ABOUT YOUR INTERESTS
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AREAS OF WORK (Select up to 2. At least 50% engaged)
    __ Elementary Ed (EE)    Secondary Schools (SS)
    Higher Ed (HE)            Adult Ed (AE)

INTEREST SECTIONS
Please check up to 3 areas of interest.
[X ] Adult Education AE................[ ] Int'l Teaching Assts ITA
[ ] Applied Linguistics AL............[ ] Materials Writers MW
[X ] Bilingual Education BE............[ ] Program Administration PA
[X ] Comp-Assisted Lang Learning CALL..[ ] Refugee Concerns RC
[ ] Elementary Education EE...........[ ] Research RS
[X ] English as a Foreign Lang EFL.....[ ] Secondary Schools SS
[ ] English for Specific Purposes ESP.[ ] Speech/Pronunciation SP
[X ] Higher Education HE...............[ ] Teacher Education TE
[ ] Intensive English Programs IEP....[ ] Teaching English to Deaf Students TEDS
[ ] Intercultural Communications IC...[ ] Video VI

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.................MEMBERSHIP OPTIONS
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A. MEMBERSHIP DUES (must select membership to receive subscriptions)
Select your category of membership based on the descriptions above.
Dues include bulk/surface rate delivery of the publications.

Fill in the correct amounts
      Individual          US$50.......................$_______
      Student*            US$36........................   $36.00
      Joint                    US$80........................_______
      Retired**           US$36........................_______

*Students: to avoid processing delays, have your supervisor sign below to
verify student status.

____________________________________________ signature

Dr. Morgan Simpson- Graduate Coordinator- School of Education- Auburn University at Montgomery  print name and title

June 2001                        estimated graduation date

B. SUBSCRIPTIONS (must be a TESOL member)
Members receive four issues yearly of TJ and/or TQ, if they choose to subscribe.
Item
TESOL Journal $22....................................._______
TESOL Quarterly $30..................................._______
TESOL Journal/Quarterly $44...........................$44

C. INTEREST SECTIONS (First IS is free. Add'l ISs are $10 each.)
Benefits within interest sections vary, but may include 2 newsletters
annually, IS listserves, participation in IS business meetings,
leadership opportunities, and voting in IS elections.

Please indicate your FREE IS choice:   EFL

Please mark your add'l IS choices:

[ ] Adult Education AE..............,.[ ] Int'l Teaching Assts ITA
[ ] Applied Linguistics AL..........,.[ ] Materials Writers MW
[ ] Bilingual Education BE..........,.[ ] Program Administration PA
[ ] Comp-Assisted Lang Learning CALL,.[ ] Refugee Concerns RC
[ ] Elementary Education EE..........,[ ] Research RS
[ ] English as a Foreign Lang EFL...,.[ ] Secondary Schools SS
[ ] English for Specific Purposes ESP,[ ] Speech/Pronunciation SP
[ ] Higher Education HE.............,.[ ] Teacher Education TE
[ ] Intensive English Programs IEP..,.[ ] Teaching English to Deaf Students TEDS
[ ] Intercultural Communications IC.,.[ ] Video VI

__ (Number of ADDITIONAL IS memberships) x $10 = CALL

D. CAUCUSES (Please mark selections. Each caucus is $13 each.)
[ ] Christian Educators CET
[ ] TESOL Part-Timers COPTEC
[ ] Int'l Black Professionals IBPFT
[ ] Nonnative English Speakers NNEST
[ ] Lesbian/Gay/Bisexual and Friends LGBF
[ ] TESOLers for Social Responsibility

__ (Number of caucus memberships) x $13 ......_______
 

E. CAREER SERVICES (Available to members and nonmembers.)
Includes both print and e-mail versions of 10 Placement Bulletins.
You should receive your first issue two weeks after your payment
is posted.
Placement Bulletin
....................[x ] Member    $28            $28.00
....................[ ] Nonmember $38........._______

F. VOLUNTARY CONTRIBUTIONS
(TESOL Awards and Grants Program)
[ ] $3 Tax-deductible charitable donation....._______

TOTAL (add subtotals A-F above)............US$ 118.00

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.................PAYMENT
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[x ] CHECK
Send check in U.S. funds drawn on a U.S. bank payable to TESOL.
(We cannot accept checks drawn on U.S. dollar accounts from
 non-U.S. banks.)
   Check #                           ........Check Amount $ 118.00

SOURCE CODE: WEB
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Mail this application with payment to:
TESOL
PO Box 79283
Baltimore, MD 21279-0283
Tel. 703-836-0774
E-mail members@tesol.edu
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