2017 Membership Form 2017 TAE4-HA Membership Form Complete this form to have your TAE4-HA membership processed. This form must be completed by December 15th each year. Upon submission, send your membership payment to the District Membership Chair/Treasurer. 2017 Membership ProcessAll members must RENEW or CREATE your NAE4-HA Member Profile online at www.nae4ha.com , found under heading "About Us", then click on Membership. Once you have completed this step, e-mail Dr. Tamra McGaughy at firstname.lastname@example.org, to confirm your membership profile has been updated or created.Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Job Title*County*Work Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work Phone Number*Work E-mail* Enter Email Confirm Email What year did you first join TAE4-HA?*Membership Dues*Active/New Member ($100)Student Member ($50)Affiliate Member ($100)NEW Life Member ($300) -for new retireesLifetime Member, with dues fully paidDistrict Membership*District 1 ($30)District 2 ($10)District 3 ($0)District 4 ($2.50)District 5 ($0)District 6 ($0)District 7 ($0)District 8 ($10)District 9 ($10)District 10 ($10)District 11 ($10)District 12 ($20)District 13/other ($0)4-H Friends and Alumni Membership (Optional)Confirming 4-H Friends and Alumni Membership ($30)Not joining 4-H Friends and Alumni at this timeLife member of 4-H FoundationTotal Amount Due $0.00 Select Method of PaymentPlease check all that apply. If you will be submitting multiple payment types, clearly indicate the amount of each of each payment Personal Check County Check District Check Cash Provide a PERSONAL CHECK number and the amountExample (CK 1234, $50)Provide a COUNTY CHECK number and the amountExample (CK 0000, $100) - if check number is unknown, use 0000Provide a DISTRICT CHECK number and the amountExample (CK 0000, $20) - verify with your District Treasurer before selecting this option (only for select districts)Provide the total amount of CASHExample (CASH $30)Upon submission of this form, you will receive a confirmation e-mail/invoice to provide to your county budget office, if applicable. This form will also be forwarded automatically to your District Membership Chair/Treasurer and the TAE4-HA Vice President.Note: Membership is not complete until your District Membership Chair/Treasurer receives payment in full.