Online Membership Form

DIRECTIONS: The following online form may be used by new and member school districts renewing their membership.
Please complete the form and press "Submit Form" at the bottom of the form.
Be sure to print a copy of the form to use as an invoice. Membership year runs from August 1 - July 31.

NOTE: Fields marked by (*) are required.

School Dist / ESU Name*
District Address*
District City, St, Zip*
District Phone Number*	( ) -
District Fax Number	( ) -
District Superintendent* First, M.I., Last
Superintendent e-mail address (Very Important)*

*Additional Contacts*
______________________________________________________________________________________________________
Upload a file Please complete the following section for any additional contacts or upload a file containing contact information. Acceptable file formats are PDF's, Excel documents, Word documents, and text (.txt) files.
Board Member #1 Name First, M.I., Last
Board Member #1 e-mail address

Board Member #2 Name First, M.I., Last
Board Member #2 e-mail address

Board Member #3 Name First, M.I., Last
Board Member #3 e-mail address

Board Member #4 Name First, M.I., Last
Board Member #4 e-mail address

Board Member #5 Name First, M.I., Last
Board Member #5 e-mail address

Board Member #6 Name First, M.I., Last
Board Member #6 e-mail address

Principal Name First, M.I., Last
Principal e-mail address

Other Administrator Name First, M.I., Last
Other Administrator e-mail address
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Dues Statement Annual NRCSA Membership Dues are *$700.00* per school district.
STOP! Before you click "Submit Form", please print a copy of the completed form/invoice to give to your business office. No additional invoices will be sent.

Confirmation Code: Enter the code shown in the box before clicking on submit.
	Note: Fields marked by an asterisk (*) are required.