Membership Form- 2021-22 School Year Name* First Middle Initial Last Email* Cell Phone*School* School Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School Phone*School Fax*Principal's Name* First Last Suptintendent's Name* First Last Please indicate your general areas/levels of athletic director/coordinator duties:* High School Only High School & Middle School Middle School Only District (Multi-HS) Assistant AD/AC Retired/Other Please indicate current additional roles/duties beyond AD/AC (if any) with your school/district: Teacher Coach Asst Principal Other Please explain other:* Please indicate source of dues payment/funding:* School/District Personal Do you currently hold a NM Administrative License:* Yes No Are you a current member of NIAAA (Nat’l Interscholastic AD Ass’n)* Yes No Number of years of previous experience as an Athletic Director/Coordinator:* MEMBERSHIP FEES High School or High School and MS/JH - $50.00 Lifetime-Retired - $50.00 MS/JH or Assistant AD/AC* or Retired or Others - $25.00 *Note – Assistant AD/AC open to assistants and administrative assistants when combined with a full $50.00 membership from the same school/districtPAYMENT PLEASE MAKE P.O.’s AND CHECKS PAYABLE TO NMAA-NMADA AND SEND TO: Tammy Richards NMAA-NMADA 6600 Palomas NE Albuquerque, NM 87109 E-mail: tammy@nmact.org Phone: 505.923.3278 Fax: 505.923.3114
