Membership Form

If you are interested in becoming a member you must send a check along with this form. Membership begins upon receipt of your check.
If you have any questions, please send inquiries to: mwiltjer@glenbrook222.org

Complete and mail this application
with your payment to:

MMC
7339 W. Ibsen Street Chicago, IL 60631

Name__________________________________________

Home address____________________________________

_______________________________________________

School/district____________________________________

School address____________________________________

________________________________________________

Home phone___________________ School phone_________________

Preferred mailing address (check one) _____Home _____School

Email address ____________________________________________

CATEGORY (circle one):
 
  • Teacher
  • Department Head
  • Supervisor
  • Curriculum
  • Administrator
  • Student
  • New Teacher
  • Retired

SCHOOL TYPE (circle one):
 
  • Elementary
  • Jr. High
  • Sr. High
  • Community College
  • College/University
  • Other ______________

MEMBERSHIP DUES

Student members (electronic only) $15
1st year teacher (electronic only) $15
Retired $20
1 year standard $27
2 years standard $50
3 years standard $70

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