WITEA
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| Name | Home Phone | ||
| Home Address | City | State | Zip |
| Place of Employment | Work Phone | ||
| Work Address | City | State | Zip |
(Circle One) Student Member ..................... $8.00 New Member .......................... $25.00 Renewal .................................. $25.00 |
Print out and complete this form, make your check or purchase order out to WITEA. Mail to....
WA-ACTE PO Box 315 Olympia, WA 98507-0315 Check and PO's should still be made payable to WITEA |
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