Affiliate/Assembly Roster Statement

PLEASE SEND UPDATES AS THEY OCCUR THROUGHOUT THE YEAR!

BY JULY 15, RETURN WITH CURRENT ROSTER TO: Director of Affiliate and Member Services, NCTE, 1111 W. Kenyon Road, Urbana, Illinois 61801-1096; fax: 217-278-3760; e-mail: .

Please use the format below and send a copy of your directory of affiliate officers and governing board to the NCTE Affiliate Director.  Be sure to include NCTE Liaison Officer, Publications Editors, SLATE Representative, and NCTE Directors (A memo providing details of the allotted number of Directors to which your affiliate entitled to will be sent in June). 

According to the rules of affiliation with NCTE described in the NCTE Constitution, Article V. Section C., all members of the affiliate governing board must be members of NCTE.  To indicate that you've checked with your officers to make sure they are NCTE members, please sign and return this form with your other forms.

Full Name of Affiliate:

Academic Year for this Statement:

___I have checked with all the persons listed as officers, editors, SLATE Representative, and members of the governing board and they affirm that they are members of NCTE.

NAME/SIGNATURE:
POSITION IN AFFILIATE:                                                                          DATE:

For each individual please include as much of this information as possible. Please use format below as a sample.

Name:	Preferred mail address: ___ (H) ___ (W)
Institution Address:	Work phone: Home phone: Fax:
Home address:	E-mail address: Date of election: Term of office: