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Membership Application
New Jersey Association for Gifted Children
Name: ____________________________________________________________________________
Mailing Address: ? Home ? Work
__________________________________________________________________________________
City___________________________________ State_______________________ Zip____________
Home Phone: ( )______________________ Work Phone ( )_________________________
County (H) _____________________________________ (W)________________________________
Email Address:
(Home)____________________________________________________________________________
(Work)____________________________________________________________________________
District/School:______________________________________________________________________
Membership for: ? Parent ? Educator ? Other________________________________________
Role in Gifted Education:______________________________________________________________
How would you like to be involved in NJAGC?____________________________________________
__________________________________________________________________________________
? New Membership ? Renewal ? Tax Deductible Contribution of $____________
Membership dues $35 for one year
? Additional $15 to receive NAGC Parenting for High Potential magazine (Parents only) Separate check payable to NAGC.
Make check for NJAGC membership payable to NJAGC and send with completed application form to:
NJAGC, PO Box 667, Mount Laurel, NJ 08054-0667
You may also pay through our website: www.njagc.org
NJAGC is a 501(c)(3) Charity (Non-Profit: Federal Tax ID # 22-3341115
NJAGC
IMPROVE TOMORROW…BY JOINING TODAY
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