CPAM
Dues
An Affiliate of
The National Council of Teachers of Mathematics
Membership Dues
2011-2012

There are now three options to pay your dues:
Option 1: Pay online with PayPal using any credit card.
Select from the two choices below. You can also pay your dues separately and make a scholarship donation with a separate payment.
Option 2: You can copy the form below and mail it with your check.
Option 3: You can download the form in PDF format
and mail in your form with your check.
Dues for the 2011-12 school year . . . . . . . . . . . $ 30.00
__ Check here if you wish to receive the Newsletter via regular mail
(Our newsletter is sent normally by email)
Voluntary contribution to the CPAM
Denise I. Griffiths Scholarship Fund . . . . . . . . . ______*
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ______
* CPAM members are encouraged to contribute at least $10.00 to the Scholarship Fund. Larger donations are welcome. All donations of any amount are gratefully accepted and are tax deductible.
Check number: ____________ Date: ____________
Checks should be made payable to CPAM, Inc. and mailed with this completed form to
Don W. Scheuer, Jr.
CPAM Database Manager
1332 Highland Avenue
Fort Washington, PA 19034-1608

DIRECTORY UPDATE
Name __________________________________________________________________
Address __________________________________________________________________
City ________________________________________
State ______Zip + 4 ___________________
Home Phone ________________________
Work Phone ________________________
Fax _____________________________
Email Address ________________________________________________________
Year of Award ______________
Award State ____________ Level __________
The U.S. Postal Service requires the extra +4 digits for bulk mailings. Please add them to your zip code.
If you have both a P. O. Box # and a street address listed, indicate which should be used for mail delivery. Unnecessary information could result in a non-delivery.
Please email your information to Don.
Questions about membership status contact:
Don W. Scheuer, Jr.
CPAM Database Manager
mathguy1@verizon.net
If you have comments
or suggestions, send e-mail to Susan
The Council of Presidential Awardees in Mathematics
would like to thank the
Teachers Development Group.
for housing our web page on their server.
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This site last updated 7/ 14/2010
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