Gwinnett Alliance for Gifted Education

Membership Form

Name: _____________________________________________ Date: _____________

Address: _____________________________________________________________

City/State/ZIP: ________________________________________________________

Telephone: _____________________ E-mail: ________________________________

Children in Gwinnett Gifted Program

Name School Grade

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Teacher/Administrator (in Gwinnett County) Membership: $20 annually

Check those that apply: _______ Gifted Program Teacher _____ Cluster Teacher _______ Administrator _____ Other: __________

_____ Elementary _____ Middle School _____ High School

Family Members:

Check one:

_____ Family ……………………………………………………….……..$25 annually

_____ Sponsor…………………………………………………….………$50 annually

_____ Patron……………………………………………………………....$75 annually

_____ Benefactor……………………………………………………...$100 annually

All contributions are tax deductible.

Make checks payable to:

Gwinnett Alliance for Gifted Education

Return your check and membership form to your child’s gifted program teacher

Or

Mail it directly to GAGE P.O. Box 490653 Lawrenceville, GA 30049