Application for Membership

Full voting membership is granted to organizations such as statewide aviation and space education councils meeting such criteria as from time to time may be set by NASEA's Board of Directors.  Additional membership categories such as Financially Contributing and Affiiated Supportive organizations and individuals may also be designated.   Currently there are no dues requirements.

If you represent a statewide aviation and space education organization or alliance, especially one chartered as a nonprofit corporation or unincorporated association, please apply as a voting member.  Otherwise express your interest by checking another appropriate category and we will keep you on our notification list.    All applicants:  please certify your application by signing and dating the form following the statement at the end.

Name of Group or Person ______________________________________________ Title ______________________
Nonprofit Corporation [ ]    Unincorporated Association [ ]      Individual [ ]     Company [ ]

Address     _________________________________________________________

Address      _________________________________________________________

City State ZIP ___________________________________  Office Phone _____________________

Group's Email Address   __________________________________________________

Contact Person  ________________________________ Contact's Phone ___________________

Contact's Email Address __________________________________________________

MEMBERSHIP CATEGORY (choose one)            Statewide Council/Group (voting) Membership [ ]
Contributing Group [ ]       Supportive Group [ ]        Company/Corporate [ ]         Individual [ ]

CERTIFICATION:   I am authorized to apply for NASEA membership on behalf of the named group or myself.  I/we agree with the objectives of NASEA as expressed in its published materials and website and will abide by any published requirements for my/our participation in NASEA.

Signed __________________________________________   date __________________________

Print name ______________________________________  title _________________________________
Please print and complete this form, and return it to:
NASEA,      149 Walnut Street        Willimantic, CT 06226
          Fax:  603 806-7937

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Page as of 02/28/2009