Please print this page and mail with check (made out to MEGAT) to

MEGAT c/o Karen McGrady

PO Box 205 - St. Albans, Maine  04971

karenwagnermcgrady <at> gmail.com

MEGAT MEMBERSHIP

Membership Year / School Year 2009 - 2010

Name ___________________________________________________________

School ___________________________________________________________

School Address ____________________________________________________

City, State, Zip ______________________________________________________

School Phone ______________________ School FAX______________________

School E-Mail _______________________________________________________

Position __________________________________ Years in GT? ______________

Home Address ______________________________________________________

City, State, Zip _______________________________________________________

Home Phone ________________________________________________________

Home E-Mail _______________________________________________________

Region (Please Check One)

_____ Northern: Aroostook, Northern Piscataquis, and Northern Penobscot

_____ Eastern: Washington, Southern Piscataquis, Hancock, and Southern Penobscot

_____ Central: Knox, Lincoln, Waldo, and Eastern Kennebec

_____ Western: Androscoggin, Franklin, Somerset, Oxford, and Western Kennebec

_____ Southern: Cumberland, York, and Sagadahoc

_____ Downeast: Washington and Northern Hancock

Single Memberships: $35.00 (Payable annually to MEGAT)