23April2019

CEASD

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Educational Program Membership - Application Form

Program Name

Mailing Address

City

State

Zip

Voice Phone Number

VP Number

Program Website

Example Website Address: http://www.ceasd.org

Name of Voting Representative 1

Title

Email Address

Name of Voting Representative 2

Title

Email Address

Name of Voting Representative 3

Title

Email Address

Name of Voting Representative 4

Title

Email Address

Name of Voting Representative 5

Title

Email Address

Name of Associate Representative 1

Title

Email Address

Name of Associate Representative 2

Title

Email Address

Name of Associate Representative 3

Title

Email Address

Name of Associate Representative 4

Title

Email Address

Name of Associate Representative 5

Title

Email Address

Name of Associate Representative 6

Title

Email Address

Name of person completing this form

Pay Now!

Dues and number of voting representatives are determined by the number of students in the program (see chart above).

NOTE: Programs may add Associate Members (no number limit) by paying $75.00 per member in addition to the program annual dues described above. Associate Members have no voting privileges, but receive the annual American Annals of the Deaf directory issue, informational emails and other communications, as well as reduced registration fees for conferences.

THANK YOU

A big THANK YOU to all the schools that contributed pictures for the CEASD website!

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