= =

MVA Membership Application as of July 1, 2010=

MVA is a Non-Profit Organization. The membership= is open to anyone. Fill out and MAIL<= /b> your Massachusetts Vocational Association (MVA) Membership Application TODAY. You may join the Associati= on for Career and Technical Education (ACTE) and/or National Association of Agricultural Educators (NAAE) with this application. MVA will forward your = dues and information to ACTE and NAAE.

FIRST NAME: _______________________ MI: ____ LAST NAME: _____________= _______________

ADDRESS:________________ CITY: ____________ ST: __ ZIP CODE: _________-_______ Check addre= ss change ___

HOME PHONE: (_____) ______-_________              &= nbsp;         HOME E-MAIL: ____________________________

SCHOOL NAME: _____________________________ &= nbsp;    WORK E-MAIL: ____________________________

ADDRESS:________________ CITY: ____________ ST: __ ZIP CODE: _________-_______ =

SCHOOK PHONE: (_____) _____-_______     EXT: _______     SCHOOL FAX: (___= __) ______-_________

Check if you are a RENEWAL: _____ or NEW MEMBER: _____

DATE of APPLICATION: ____________   <= /span>School Rep.___________________________<= /b>

Please Select a Field of Specializatio= n for ACTE and MVA=

___ ADM Administration        =                =             &nb= sp; &nb= sp;            =                &= nbsp;            NRS &n= bsp;     New and Related Section

___ AWD Adult Workforce Development         =            &= nbsp;                &= nbsp;            ___ B     Cooperativ= e Work Experience         =

___ AGR &n= bsp; Agricultural Education        =                        &= nbsp;                    &= nbsp;            ___ S      Informati= on Technology

___ BUS &n= bsp; Business Education        =             &nb= sp;       =         &= nbsp;                    &= nbsp;            ___ C     Instructional Materials

___ CAR    Career Academy        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;     ___ F      Integrati= on of Acad & Career & Tech Ed

___ FAM Family & Consumer Sciences Ed.  &nbs= p;         &= nbsp;                    &= nbsp;            ___ I      Internati= onal

___ GUI &n= bsp;   Guidance and Career Development                 =                  =          ___ H     Maker of Policy=

___ HEA &n= bsp; Health Science Technology Ed   &nbs= p;             &= nbsp;                    &= nbsp;            ___ D     Personnel Devel= opment

___ MAR <= /span>Marketing Education     &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            ___ E    Public Information

___ SPE &n= bsp;   Special Populations     &= nbsp;       =             &nb= sp;           &= nbsp;                    &= nbsp;            ___ G    Research

___ TGY &n= bsp; Engineering and Technology Ed    &n= bsp;            = ;            &n= bsp;            = ;       ___ R     ROTC=

___ TRA &n= bsp; Trade & Industrial Education   = ;            &n= bsp;            = ;            &n= bsp;            = ; ___ N    School-to-work/Careers

                 =             &= nbsp;           &nbs= p;         &= nbsp;            &nb= sp;            =                &= nbsp;           &nbs= p;            &= nbsp;         ___ J     Support Staff

        =                    =             &nb= sp;           &= nbsp;                    &= nbsp;                    &= nbsp;           &nbs= p;            &= nbsp;         ___ M    Tech Prep<= /span>

.        =         =             &nb= sp;                   &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp; ___ O  &nb= sp; Teacher Educator

        =           =            &= nbsp;                    &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp; ___ P     Safe Schools

        =             &nb= sp;            =             &nb= sp;       =                   &= nbsp;           &nbs= p;            &= nbsp;                 &= nbsp;            ___ K     Other        =

Please Select a Job Classification for ACTE and = MVA        &= nbsp;           &nbs= p;

___ T     Teacher        =             &nb= sp;            ___ E    Teacher Supervisor     &nb= sp;

___ S      Student        =             &nb= sp;            ___ K    Counselor &n= bsp;            = ;            &n= bsp;

___ B &n= bsp; Business Industry Rep        ___ R &n= bsp; Retired

___ X &n= bsp; Teacher Educator        =        ___ O      Other

___ A &n= bsp; Administrator Supervisor

Please Select Principle Employment for NAAE by checking one of the following:

___ Secondary Schoo= l AG Teacher

___ Middle School AG Teacher

___ Postsecondary 2= yr AG Teacher

___ Young Farmer/Ad= ult AG Instructor

___ University Faculty and/or Teacher Educator

___ State AG ED Sta= ff

___ Retired

NAAE Types of Membership=

= ;

Active            Anyone who is professionally qualified to teach agriculture in K-12 or       = ;    $60/year

        =              =    postsecondary public or private sch= ools or state staff     = ;            &n= bsp;            = ;          $720/life

Associate       Any= one engaged in agricultural education who are not professionally         &= nbsp; $35/year

     =             &nb= sp;      qualified to teach agriculture    = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;     $420/life

Retired           Anyone qualified to be an active or associate member who has <= o:p>

     =             &nb= sp;      retired from the profession - Life Active members who retire will         &= nbsp;

     =             &nb= sp;      automatically be moved to Retired Life membership without any             =       $35/year

     =             &nb= sp;      additional payment      =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;      $120/life

Student          Undergraduates training for careers related to agricultural ed= ucation        &= nbsp;     $10/year

        &= nbsp;           &nbs= p;            &= nbsp;

Massachusetts Vocational Association   = MVA other benefits go to www.massvocassoc.org

            =             &nb= sp;            =             &nb= sp;            =

___ $    30.00 -- MVA Active        &= nbsp;

___ $    10.00 – MVA Loya= lty        &= nbsp;           &nbs= p;                  &= nbsp;           &nbs= p;            &= nbsp;         MVA        &= nbsp;      $ _________

=

=

Optional Organization you may join alon= g with MVA.

            =             &nb= sp;            =

Category I, Association for Career and Technical Education (ACTE Optional)

ACTE other benefits go to www.acteonline.org

            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;

___ $    80.00 – ACTE

___ $    31.00 – ACTE Loy= alty        &= nbsp;           &nbs= p;

___ $    10.00 – ACTE Stu= dent        &= nbsp;           &nbs= p;                 &= nbsp;           &nbs= p;            &= nbsp;         Category I        $ _________     &nbs= p;

Category II, National Association of Agricultural Educators<= /b> (NA= AE Optional)

NAAE other benefits go to www.naae.org

            =             &nb= sp;            =

___ $      60.00 – NAAE Active

___ $   720.00 – NAAE Active L= ife

___ $      35.00 – NAAE Associate<= o:p>

___ $   450.00 – NAAE Associat= e Life

___ $      35.00 – NAAE Loyalty              &= nbsp;           &nbs= p;            &= nbsp;
___ $   120.00 – NAAE Student = Life        &= nbsp;                   &= nbsp;           &nbs= p;            &= nbsp;         Category II      $ _________

Add MVA dues and Category I and/or Category II (= if applicable)     TOTAL             $ _________

IF YOUR SCHOOL OFFERS PAYROLL DEDUCTION, PLEASE SIGN AND DATE BELOW.

            =             &nb= sp;            =             &nb= sp;            =

I authorize the= business office to deduct my MVA or MVA/ACTE or MVA/NAAE or MVA/ACTE/NAAE dues from = my pay each year. If in the future I dec= ide to quit the MVA, I will in writing notify payroll 30 days before t= he start of the payroll deduction begins for the new year.

Payroll Deduction: _____________________________= _____        &= nbsp;   Date Signed: _____________________

            =             &nb= sp;            =             &nb= sp;            = Signature=

Purchase Order: #_____________   or   Check: #_____________       Enclo= sed is: $____________<= /span>

Mail application with to: MVA, 24 = Keene Road, East Freetown, MA 02717-1722