TESL Ontario Membership Application Form

New Member
Renewal

Name: ________________________________________
Address: ________________________________________
________________________________________
City: ________________________________________
Postal Code: ________________________________________
Home Telephone: ________________________________________
Office Telephone: ________________________________________
Fax: ________________________________________
E-mail: ________________________________________
Employer: ________________________________________
________________________________________
Affiliate Choice (indicate 1 only)
Durham
Hamilton/Wentworth
Kingston
London
Niagara
North York/York Region
Ottawa
Peel/Halton/Etobicoke
Sudbury
Toronto
Windsor
Not Affiliated
Teaching Level (indicate 1 only)
Pre-School
Elementary
Secondary
LINC
Adult Credit
Continuing Education
College/University
Private School
Selected Fee (indicate 1 only)
Regular
Volunteer
Student
Friends of TESL
Business
Library
Immigrant Services
International
Joint
Amount Enclosed:$______________________
Payment may be made by cheque or VISA.
Visa#:______________________________ Expiry Date:________
Signature:_____________________________________________

Willing to Volunteer:
For general Association work
For conference work

For Office Use:
Membership Rec'd__________________ $_______________
Expiry Date:________________ (month/year)
Paid by: Cheque Cash Visa

GST REGISTRATION NUMBER R126198043

Fee Schedule (includes GST)
REGULAR (within Canada) $84.00
VOLUNTEER* $58.00
STUDENT** $58.00
FRIENDS OF TESL (retired/unemployed) $58.00
BUSINESS (educational publishers) $373.00
LIBRARY $79.00
IMMIGRANT SERVICES (non-government agencies) $89.00
INTERNATIONAL (living outside Canada) $100.00

Notes:
* Please submit a letter from supervisor.
** Part-time or full-time students use this category twice only. Submit a copy of student fee payment.

Please send this form with your cheque (payable to TESL Ontario/Membership):

TESL Ontario/Membership
27 Carlton Street, Suite 405
Toronto, ON M5B 1L2