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Thank you for your interest in joining SMCAA!

To become an Affiliate Member of SMCAA simply fill out and submit the form below. You will receive an e-mail confirmation of your registration details, keep this for your records.

SMCAA Membership Year is from July 1 to June 30.

SMCAA 2020 - 2021 Affiliate Membership Form
Unless otherwise indicated, all information is required.

 
 

Membership Level:

$500 Affiliate Group Membership (non-District)
        Membership fee is non-refundable.
 
 
 
Organization's Name:
 
 

Primary Contact's Name:
First Name:   Last Name:
 
Primary Contact's Email:
Address:
City:
State:
Zip code:
Phone #:
   
 
Accounts Payable Contact
First Name:
Last Name:
   
Email:
Phone:

 

 ALTERNATES (optional)

 

In addition to a Primary Representative, you have the option of identifying and assigning up to eight alternate representatives.
The Primary and the Alternates all receive access to member correspondence.
NOTE: Email addresses must be unique.


Alternate #1's Name:
First Name:   Last Name:  
   (optional)
Alternate #1's Email: (optional)
   

Alternate #2's Name:
First Name:   Last Name:  
   (optional)
Alternate #2's Email: (optional)
   

Alternate #3's Name:
First Name:   Last Name:  
   (optional)
Alternate #3's Email: (optional)
   

Alternate #4's Name:
First Name:   Last Name:  
   (optional)
Alternate #4's Email: (optional)
   

Alternate #5's Name:
First Name:   Last Name:  
   (optional)
Alternate #5's Email: (optional)
   

Alternate #6's Name:
First Name:   Last Name:  
   (optional)
Alternate #6's Email: (optional)
   

Alternate #7's Name:
First Name:   Last Name:  
   (optional)
Alternate #7's Email: (optional)
   

Alternate #8's Name:
First Name:   Last Name:  
   (optional)
Alternate #8's Email: (optional)
   
   
   

BILLING INFORMATION

Amount to Bill:
   
Billing Options: Bill me now (before June 30)
I prefer delayed billing (after July 1)
   
Purchase Order #:
   

By submitting this registration form I hereby agree:

  • to give permission to SMCAA, granting full right of ownership and free use without restriction of photographs of myself, for any and all purposes in promoting education in Missouri, including but not limited to printed publications, websites, and electronic newsletters.
  • that the Membership Fee irrevocable and non-refundable.

     

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