MISBO Application for Membership

Membership Application for 2008-2009

*Indicates a Required Field

Date: *
School: *
Mailing Address: *
City:*
State :*
Zip Code:*
Phone:*
Fax:*
School Website:
 
Number of Students:*
Grades:*
 
Contact Name:*
Title:*
Phone:*
Fax:*
Email Address:*
   
Ship To School:*
Street:*
City:*
State:*
Zip Code:*
   
Would you like to be added to the MISBO listserv? Yes

Submit the following for membership:
» 501 (c) (3)
» Tax exemption letter (if applicable)
» Check for membership dues of $1.25 per student (min of $100), + $250
   if participating in the Interstate Risk Management Insurance Program.
» A signed Agreement form
» Completed Personnel Information form
» $500 for schools (outside of the core states) who want to opt out of Purchasing &
    participate only in the Insurance Program. No student fees.

*Your membership is not valid until all the above have been received.
**Send us your school's external/outside IP address. (To view the IP restricted webpages with contact/discount information, our server has to recognize your IP to let you in.)