Please complete this form and mail with payment to:

EECSD Membership
PO Box 68
Mission Hill, SD 57046
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Name:

Address:

City:				

State:		

ZIP:

Email:

Phone:
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Area of EE Interest:

___Classroom Teacher

___Nonformal Educator (zoos, museums, nature centers)

___Agency Outreach Staff

___Youth Worker (paid or volunteer)

___Other
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Membership Level:

___Student 

___Individual

___Family

___Institutional

___Commercial

___Life