AEGUS Membership Form
Please complete and mail to:
Margie Boudreau
AEGUS Membership Chair
P.O. Box 221
Mountain Lakes, NJ 07046
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Name
_____________________________________________________________________
Address
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City
State Zip
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Telephone number (home) (work)
_____________________________________________________________________
Email address
Check any of the following that apply:
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__ general education teacher |
__ special educator |
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__ reading specialist |
__ resource teacher |
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__ counselor |
__ therapist |
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__ parent of gifted student |
__ elementary student |
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__ middle school student |
__ high school student |
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__ college student |
__ other |
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__ Life membership |
$ 250.00 |
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__ Gift Membership |
$ 25 |
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__ I would like to make a tax-deductible donation to AEGUS to support their efforts to advocate for underachieving students, in the amount of $ _______ |
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Check enclosed, made payable to AEGUS, for the total amount of $_________ |
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How did you hear of us: ________________________________________________________ |
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