Affiliate Renewal Form

Thank you for the work your affiliate has done this past year in the field of mathematics education. We look forward to supporting our affiliates in this upcoming year as well.

Please complete this online form, retaining a copy of the information for your files.

To avoid losing your work due to technical issues, please prepare your responses separately, and then copy-paste responses here.

Affiliation dues are $80. They cover the fiscal year beginning February 1, 2017 and ending January 31, 2018 and are non-refundable. Dues may be paid directly through this form or mailed to the AMTE Treasurer:

Anita Wager
Vanderbilt University, Peabody College
Department of Teaching and Learning
230 Appleton Place, PMB 230
Nashville, TN 37203

If you have any questions or need additional information, please contact the Associate Vice President for Affiliates by email to amteaffiliate@gmail.com

Total Amount

Affiliate Profile

Contact Email *

Name of Affiliate *

Affiliate President *

President Term Expires *

President AMTE Member ID *

Affiliate Presidents are required to be members of AMTE. To find your Member ID, login to AMTE, and click the "view my account" link in the left sidebar.

President Phone *

President Email *

List of Affiliate Events for the Upcoming Year, including dates and locations.

List of All Current Members (Name, Organization, Email)

Strengths of the Affiliate *

Challenges Affiliate Faces in Pursuing its Mission and Goals *

Would someone in your affiliate be interested in talking with an ACC member regarding affiliate needs? *

Yes No

Have you updated the affiliate directory page since the last annual report? *

Yes No

Representative Who Will Update Affiliate Information on AMTE Website *

Representative Email *

Questions/Comments

Credit Card Information

To make your payment, please either click the PayPal button or fill in the credit card and billing information and click Confirm Contribution at the bottom of the page.

Checkout securely. Pay without sharing your financial information.

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *