PROGRAM GUIDE - American Council on The Teaching of Foreign ...

Special Interest Groups
Would you like to join an ACTFL Special Interest Group (SIG)? Enjoy one FREE
SIG membership. Additional SIG memberships are optional and carry a fee of
$5.00 per year per group. SIG membership must be paid for the same period as
ACTFL membership. On the other side is a brief description of each SIG.
Indicate your FREE SIG choice by filling the box in solid “ n ”. Use a checkmark to indicate
additional SIG groups you wish to join “ ”.
African-<strong>American</strong> Students
Arabic
Community College
Distance Learning
Film (Cinema)
Heritage Languages
Immersion
Korean
Language Learning for Children
Demographic Information
Less Commonly Taught Languages
Modern Greek
Portuguese
Research
Small German Programs
Spanish for Native Speakers
Teacher Development
Teaching and Learning of Culture
What language(s) do you teach? check all that apply
Chinese ESL French
German Italian Japanese
Latin Russian Spanish
Other(s):
What is your current assignment(s)? check all that apply
Teacher Methods Instructor
Student Administrator
What level(s) do you teach or administer? check all that apply
Elementary Middle/Junior High School High School
Community College Undergraduate Graduate
Government/Business/Non-Degree Institution
MeMbership ApplicAtion
For new or reinstating members only, not to be used for renewals
Join online at www.actfl.org.
Alternatively, you can fill out this application. Please print or type clearly, and complete all applicable fields to expedite processing. Submit completed
application to ACTFL, P.O. Box 34949, Alexandria, VA 22334-0949 with payment, or fax credit card payments to (703) 894-2905.
Given (First) Name
Surname / Family Name
Home Address
City | State | ZIP/Postal Code | Country
Phone | Fax
Home E-mail
Preferred Mailing Address check one: Home Work
Preferred Billing Address check one: Home Work
ACTFL regularly communicates with its members by
e-mail and/or fax. By supplying your e-mail address
or fax number you are consenting to receiving communications.
At any time you may unsubscribe from
subsequent messages by following the directions in a
received communication. Fax numbers provided should
be able to automatically receive 24 hours a day, 7
days a week.
ACTFL occasionally makes its membership list
available to companies offering products and services
of interest to our members. Members’ phone numbers,
fax numbers, and e-mail addresses are for ACTFL’s use
only. If you would NOT like your name and preferred
mailing address to be included in these mailings,
please check this box.
Check made payable to ACTFL
drawn on a U.S. bank
Purchase Order
must be enclosed with application
Institution / Company Name
Institution / Company Address
City | State | ZIP/Postal Code | Country
Phone | Fax
Institution / Company E-mail
Twitter Username
Referred by a Member? Help us give them credit!
Referring Member’s Name
Referring Member’s ID Number
Fees
Basic Fee select one
All fees are for one year unless designated for multiple years.
Regular $ 75.00
Two years $ 140.00 for two years
Three years $ 201.00 for three years
Adjunct/Part-time Educators $ 50.00
New Teacher (two-year max) $ 50.00
Student $ 25.00
Expected Graduation or Program Completion Date:
Basic Fee Total = $
Additional Fees optional, select all that apply
1 FREE SIG indicate which SIG by filling in solid the checkbox to the left “ n ”
Additional SIG(s) indicate which SIG(s) using a checkmark in the checkboxes to
the left “ ”
# of SIG(s) x $5 x years = $
Joint see reverse side for eligibility and restrictions
$20 x years = $
Partner Name:
International for shipment to an address outside the United States
$20 x years = $
Additional Fee Total = $
Donation optional
Discover Languages . . . Discover the World! – Sustained public awareness
campaign promotes the value of language learning. see reverse for more information
Optional Donation Total = $
TOTAL DUE Basic + Additional + Donation = $
Payment Information Please print or type clearly and complete all information to expedite processing.
Credit Card: Visa MasterCard <strong>American</strong> Express
Number Expiration Date
Name on Card | Signature must be included with all credit card charges
Revised 08/15/12