Individual New Membership Application

Online: For fastest processing, join online at www.tesol.org/join

By phone: +1 240.646.7048 (888.547.3369 toll-free in the United States and Canada)

1. Profile Information 2. Membership Dues

(*Required fields. Please print clearly.) All prices are in U.S. dollars. Membership categories cannot be changed
except at the time of renewal.
*Female ✔ Male Membership LEVEL 1 Year 2 Years
27
*Birth Date: Day________ 04
Month_______ 1990
Year_______ Professional Member $98 $166 (Save 15%)
Professional Member with an
*Mr. Ms. ✔ Mrs. Dr. Other annual income of US $25,000 $65 $111 (Save 15% )
or less
Nagwan
*First (Given) Name______________________________ M.I.___________
New Professional $60 $102 (Save 15%)
Gharrawi
*Last (Family) Name___________________________________________ For teachers who have been teaching less than 3 years. If you have been
teaching for 3 or more years, please choose Professional Member.
*Mailing Address: This is your: Home Address Work Address ✔
Global Professional $35 $60 (Save 15% )
*Address Line 1__University of Basra
_____________________________________________ For residents of countries with a gross national income (GNI) per capita of less than
US$15,000, as determined by the United Nations. To learn if your country is eligible,
Address Line 2 _______________________________________________ go to www.tesol.org/join. This category carries full membership rights and privileges.
Requires a valid e-mail address to process.
Basra
*City_____________________________ *State/Province__Basra
____________ Retired Professional $57 $96 (Save 15% )
*Zip/Postal Code __61
___________________ *Country__Iraq
_________________ For retired professionals who have been TESOL members for 5 of the past 10 years.
Verification of retirement is required for first year of Retired Professional membership.
University of Basra Student Member $35 $60 (Save 15%)
Employer/Institution Name:______________________________________
For students who are at least half time at a degree-granting institution. Student
Basra
City, State/Province____________________________________________ members must verify enrollment with either a note from an academic advisor or a
copy of a valid student ID. After 6 years as a Student Member, you will be automati-
Iraq
Country____________________________________________________ cally converted to a New Professional.
SUBTOTAL Dues:
Telephone and E-Mail
Please provide country and city codes for non-U.S. phone numbers.
3. Member Subscriptions
Office: If you selected a 2-year membership, you must subscribe to your journal for
Tel. Country Code Phone Number ext 2 years.
Home: +9647703107990 TESOL Quarterly, scholarly journal. 1 Year 2 Years
Tel. Country Code Phone Number ext Electronic access only: $59 $118
Fax: Electronic access and print $85
$89 $170
(4 issues per membership year): $178
Country Code Phone Number ext
For Global Professionals $45 $90
najwanhatem@yahoo.com
Preferred E-mail: ____________________________________________ (electronic access only):

oceanheart1990427@gmail.com SUBTOTAL Subscriptions:

Alternate E-mail: ____________________________________________
Privacy Preferences
E-mail is required for the Global Professional Membership and to receive
electronic newsletters.
Exclude me from promotional offerings other than from TESOL
Affiliate (List the TESOL affiliate to which you belong, if any.) Yes No
Did someone refer you to TESOL? Yes No
________________________________________________________
TESOL membership does not include affiliate membership, nor does membership in Print name of referrer:__________________________________________
an affiliate grant you TESOL membership.
TOTAL DUE: $___________

4. PAYMENT Credit card: Specify: VISA MC AMEX

Please allow 1-2 weeks for processing of application if mailed or faxed. Mail com-
pleted form with payment information to TESOL, PO Box 111, Annapolis Junction,
MD 20701 USA or fax to +1 240.396.5631
TOTAL SENT: US $_________ (Send amount equal to TOTAL DUE)
Check or Money Order:
Personal Corporate Check Money Order
Check # __________________________ for US $________________
Western Union® (WU)
Fax this completed application to +1 240.396.5631 and indicate that a WU
payment will follow. There may be additional fees with this option.
Visit www.tesol.org/Join, then select Payment Options.
WEB2013
Cardholder’s name____________________________________________
Credit Card #________________________________________________
Exp. Date_____________________ Security Code__________________
(_ Security code: VISA/MC–last 3 digits on reverse of card. AMEX 4 digits above card number
on front).
Daytime Phone # (Required) ______________________________________
Cardholder’s Signature___________________________________________
Wire Transfers
For instructions, contact wiretransfers@tesol.org or TESOL, Attn. Wire Transfers.
Note: TESOL cannot accept purchase orders for membership.
Questions: E-mail: members@tesol.org • Phone: +1 703.836.0774
Mail: TESOL Member Services, 1925 Ballenger Ave., Suite 550, Alexandria, VA 22314