Name:  
Home Address:  
City/State/Zip:  
School Name:  
School Address:  
City/State/Zip:  
Employing District:  
Position:  
Send mailings to:  Home:    School:  
School Telephone:  
Home Telephone:   
Fax:   
E-Mail:  
Sponsored/Recruited by:  

MAESP Dues
Indicate the amount of your MAESP Dues by selecting one of the choices below:
$279 Active (for principals & asst. principals) $139.50 First Year Principal $25 Retired $279 Lifetime Retired $330 Institutional $25 Student/Aspiring $150 Associate

Dues for first-year administrators are 50% of active amount (one-time benefit only)
Check here if you are a first-year administrator and adjust your payment accordingly
Check here if you are including $20 for Southwest District Dues
Check here if you are including $35 for St. Louis Suburban District Dues
Check here if you are including $20 for Southeast District Dues
Check here if you are including $20 for Northeast District Dues
Return to MAESP Membership page for more information about membership categories

NAESP Dues
If you wish to join NAESP at this time, indicate the amount of your NAESP dues by selecting one of the choices below.  Add the amount of your NAESP dues to your total remittance:  
I do not wish to join NAESP at this time Active $215 Aspiring $70 Retired $55 Emeriturs (retired with more benefits) $108 Associate $115 Institutional Active $260 Institutional Subscription $140 International Associate $145

Spring Conference Registration
Check here if you would like to include registration fee of $215 for the MAESP Spring Conference.

MAESP Building Fund Donation
Check here if you would like to donate $35 toward the 2010-11 MAESP building fund.

Total remittance:  $ 

Your MAESP District (select one)
01 Central 02 Clay-Platte 03 KC Suburban 04 Jefferson County 05 Kansas City 06 Northeast 07 Northwest 08 St Joesph 09 St Louis 10 St Louis Suburban 11 South Central 12 Southeast 13 Southwest 14 Springfield

How are your membership dues paid?
I pay out of my own pocket and am not reimbursed.
The school board either pays or reimburses me for dues.

I wish to receive:
A MAESP membership certificate and card
A MAESP membership card only

The following demographic information would greatly assist MAESP in association planning for elementary principals:

Salary:  
Years in Education:  
Years in Principalship:  
Years in current position:  
Years in MAESP:  
Years in NAESP:  
Years until eligible for retirement:   0 - 5 5 - 10 More than 10

Method of Payment
  Personal Check
 School Check
 Purchase Order #  
 Credit Card:  If you wish to pay by credit card (Master Card, Visa or Discover), please complete your enrollment form, submit and then call the MAESP office at 573-638-2460 to insure confidentiality of your credit card information.