Prof. Brent Gibson 
CCTE Executive Secretary 
Dept. of English 
University of Mary Hardin-Baylor
Box 8008
Belton, TX 76513

Individual Membership / Dues Form

If you wish to pay your dues individually, use this form.  You may prefer to pay your dues through the departmental representative (see your department chair for name), who will send a department roster of CCTE members.  Life members and honorary members do not pay dues. Individual dues are $20.00. Make checks payable to CCTE.

Name: __________________________________________________________

E-Mail: _________________________________________________________

Department: ______________________________________________________

Institution:________________________________________________________

P.O. Box/Street:___________________________________________________

City: ________________________ State: _____ Zip (+ 4, please):____________

Telephone: (       )_____________________ Fax: (       )____________________