NEA DELEGATE CAUCUS REGISTRATION 13

NEA DELEGATE CAUCUS REGISTRATION (Check all that apply and return the complete sheet.) _____ I will attend the NEA Deleg...

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NEA DELEGATE CAUCUS REGISTRATION (Check all that apply and return the complete sheet.) _____ I will attend the NEA Delegate Orientation on June 15, 2013 from 1:00 p.m. – 3:00 p.m. _____ I will not be able to attend the NEA Delegate Orientation on June 15, 2013. NAME_______________________________________________ (Please print or type) HOME ADDRESS__________________________________________________________________ __________________________________________________________________ HOME PHONE (____) ____________________ SCHOOL PHONE (____) ____________________ PLEASE CHECK ALL THAT APPLY: _____ I am attending for the first time. _____ Consider me for a Caucus Committee (check one): ___ Legislative Program Committee ___ New Business Items ___ Delegate Communications ___ Seat Covers/Delegation Monitors

___ Elections ___ Vilma Leake First Timers Club ___ Candidate Greeters ___ Where Needed ___ Position Sign Carriers ___ NEA-FCPE-Auction (NEA-Fund for Children and Public Education) -------------------------------------------------------------------------------------------------------------------------------------------

SPECIAL DIETARY NEEDS: Please specify ____________________________________________ ------------------------------------------------------------------------------------------------------------------------------NCAE DELEGATE JACKETS    

This year’s delegate jackets will be identical to last year’s jackets. If you received a jacket last year, please bring it with you to Atlanta. If you did not attend last year’s RA, please indicate the size you wish to order (cost applies). Returning delegates may order a new jacket by indicating the requested size (cost applies). Please check your jacket size.

_____ Small _____ Medium _____ Large _____ X Large

Women _____ 2X Large

____ Small ____ Medium ____ Large ____ X Large

Men _____ 2X Large _____ 3X Large _____ 4X Large _____ 5X Large

_____ Enclosed is my $35 check payable to NCAE for the purchase of a Delegate Jacket. For sizes 2X and up please add an additional $2.00 per size. (Example: 2X $2.00; 3X -$4.00; 4X Jackets will be $6 extra). _____ I do not wish to purchase a jacket. ----------------------------------------------------------------------------------------------------------------------------Please return this form by mail or email to [email protected] and MAIL your check for a jacket to Carolyn Evans, PO Box 27347, Raleigh, NC 27611 by May 10, 2013. U:\Docs\NEA Delegate Caucus Registration