American Irish Teachers Association
Membership Form

Check Applicable: Regular & Associate    $15 [     ]    Family  (2) $25   [      ]    Change Address    [    ]

First Name: __________________M.I. ­­­­_____Last Name: ____________________
Affil / Company (if not to home): ______________________________________
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Address: ______________________________________________Apt#:______
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City: ___________________      State: ___________________    Zip+4:_____
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Home Phone: ____________________            Work Phone: __________________

E-mail: __________________________  Enclosed is my check for: _____________

Applicable Years: ___________________

 Mail to:
American Irish Teachers Association

6 East 87th Street

New York, NY 10128-0454