Morris County School Media Association

Membership Application

Please complete this form and bring it to the next meeting with a check for $15, or mail to Kathryn Valvano, Media Specialist - Morris Hills H.S. – 520 W. Main St. Rockaway, NJ 07866

Name:___________________________________________________________

School/Address:       ________________________________________________

                                    ________________________________________________

________________________________________________

Grade Level: ________

District: _____________________________

School Phone: ____________________School Fax: ______________________

School E-Mail Address:___________________________

School Web Site Address:___________________________________________

Home Address:         ________________________________________________

_______________________________________________

Home Phone: _______________________