Alumni Association Affiliation and Profile Form

*Denotes information is required and will be posted on the National TSA Alumni Association directory.

National Alumni Association dues plus applicable state dues

*Please select alumni state:

State dues:
Annual ( 0)
5-year ( 0)
Lifetime ( 0)

National dues:
Annual ($15)
5-year ($60)
Lifetime ($150)

Check here if this is the 2nd (or more) TSA State Alumni Association you are registering with. ($0)

*First Name	*Last
Maiden Name
Street Address
City	State Zip
Country
*Email
Phone
*User Name	(Used to allow you to update your information later)
*Password
*Confirm Password

*Past affiliation with TSA (check all that apply):
    Chapter Member
    Chapter Officer
    State Officer
    National Officer
    Chapter Advisor
    Other

*Name of school(s), including city and state where you participated in TSA:

*Year completed high school:

Areas of interest (check all that apply):

Volunteering at conferences:
    Regional
    State
    National

Serving on a National TSA Alumni Association committee, such as the alumni committee, alumni council, membership, finance, fundraising, awards, public relations, resolutions and bylaws committee.

Current career information: (optional)

To be named a Founding Member you may make a onetime donation to the National TSA Alumni Association of $300 in addition to yearly dues.

INVOICE

National Dues:	$0.00
State Dues:	$0.00
Contribution:	$0.00
Total:	$0.00

PAYMENT


Card Type *
Card Holder Name *
Card Number *
Expiration Date *

Thank you for supporting TSA.

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