Affiliate Network Membership Application

1. Affiliate Network Membership Application

An organization can apply to become a member of the Affiliate Network by completing this application. The Steering Committee will make a determination of membership and inform the applicant organization in a timely manner.

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* 1. Organization applying for Membership in the Affiliate Network:

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* 2. Organization Contact Information

Email:

Phone:

Street Address:

City:

State/Province:

Postal Code:

Country:

Website:

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* 3. Mission Statement:

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* 4. Is your mission statement compatible with that of NAAEE?
(NAAEE Mission Statement:
The North American Association for Environmental Education promotes excellence in environmental education and serves environmental educators for the purpose of achieving environmental literacy in order for present and future generations to benefit from a safe and healthy environment and a better quality of life.)

Yes

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* 5. Affiliate Status

Which state, province, region, or country does this organization represent?

Is there another organization serving as the Affiliate for the state, province, region, or country stated above?

If yes, organizations within a state or province must present a unified application from all organizations and identify the unique situation requiring that more than one organization be a member of the Affiliate Network in order to effectively represent environmental educators in that state or province:

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* 6. How does this organization offer services to and represent environmental educators in the state, province, region, or country stated above? (100 word maximum):

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* 7. Does this organization represent a significant portion of the environmental educators in that state, province, region, or country?

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* 8. We commit to the following to retain status as a member of the Affiliate Network:
* Maintain a partner membership in NAAEE (see http://www.naaee.org/membership for details)
* Publicize NAAEE membership and events in communication, such as newsletters, conference materials, and websites.
* Acknowledge membership in the Affiliate Network in communication, such as newsletters, conference materials, and websites.
* Designate one or two representative(s) to serve as liaison(s) to the Affiliate Network.

The Affiliate Liaison(s) will:
a) serve as main communication link between your Affiliate organization, NAAEE and the Affiliate Network
b) maintain individual membership in NAAEE
c) represent the affiliate at the Affiliate Network pre-conference workshop, and the NAAEE annual conference, as funds allow
d) participate actively in the governance of the Affiliate Network
e) participate in the Affiliates listserv
f) provide the addresses (including phone, fax and email) for the Affiliate Liaison(s), and provide updates in a timely manner, to the Chair of the Affiliate Network Steering Committee and to NAAEE
g) at the end of your service, meet with new, incoming Affiliate Liaison(s) for your organization to provide background and orientation materials, review current issues and activities, provide contact information, and review Affiliate Liaison responsibilities and communication process

Primary Representative First Name:

Last Name:

Email:

Phone:

Street Address:

City:

State/Province:

Postal Code:

Country:

*Optional* Secondary Representative First Name:

Last Name:

Email:

Phone:

Street Address:

City:

State/Province:

Postal Code:

Country:

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* 9. I certify that the information provided in this application is complete and true to the best of my knowledge.

Name:

Association with Applicant Organization (i.e., Board President, Executive Director, etc.):