Membership

Membership Application and Professional Dues Statement

June 12, 2009

MISSOURI ASSOCIATION
OF SCHOOL ADMINISTRATORS
(MASA Membership Year is from July 1, 2009 to June 30, 2010)

Name:
Position:
School District:
School Address:
City/State/Zip:
Telephone Fax
E-Mail

Home Address (optional):
Home Phone (optional):
Check Membership Status:

Active - Dues for MASA will be .0050 of your 2009-2010 salary, rounded to the nearest dollar. MASA accepts your determination of the amount. Do not list salary, only dues! (Example: $70,000 X .0050 = $350).

District - MASA state membership for multiple central office members. The cost of a district membership is equal to the active membership fee paid by the superintendent of schools and entitles a school district to designate one voting member. (See below to list names of staff members covered.)
Select the MASA district in which you are located:

Are your dues paid by: Individual School District

Payment Information
MASA Active Membership Dues $
MASA School District Membership Dues $

2009-2010 AASA Active Membership Dues for districts
with enrollments greater than 350 ($403) $

2009-2010 AASA Active Membership for Small Schools
with less than 350 enrollment: ($180) $

TOTAL DUE: $

Method of Payment
Check will be mailed made payable to MASA.
Purchase Order Number: (please invoice)
Credit Card: If you wish to pay by credit card (MasterCard or Visa), please complete your enrollment form, submit and then call the MASA office at 573-638-4825 to ensure confidentiality of your credit card information.

School District Membership Information

Any school district whose superintendent is an active member may purchase one additional school district membership which may be utilized by all central office assistants.

Name and position of designated voting member:

Names and positions of other central office personnel who may utilize the district membership (non-voting members):
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.