School _______________________________ District_________________________________
Contact Name __________________________Title ___________________________________
Address ______________________________________________________________________
City _________________________________ State __________________ Zip Code ________
Telephone ____________________________ Fax ____________________________________
Affiliate Membership Fee is $250.00 per year for an individual school or district.
MAKE CHECKS PAYABLE TO IAES AND SEND TO:
IAES 333 Education Building 1310 S. Sixth St. Champaign, IL 61820
Tel: 217-244-5680