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Print Form College of Alberta School Superintendents Affiliate Member Registration Application Form July 1 2011 - June 30 2012 Employee of the Ministry of Education in a senior supervisory or consultative position Academic member of a university faculty Member of the the Saskatchewan League of Educational Administrators Directors and Superintendents System Education Leader from the Yukon or Nunavut. I am familiar with the the College of Alberta School Superintendents Professional Code of Conduct as presented on the CASS website at www. cass. ab. ca Name Last First Position Held Jurisdiction Email Address City/Town Province Work Phone Cell Signature Insert digital signature or print form and manually sign Postal Code Fax Date FEES Fees are due no later than October 31st. CASS membership fee is comprised of 250. 00 plus GST of 12. 50 for a total of 262. 50 GST Number - 10696 7052 RT PLEASE NOTE The jurisdiction will be sent an invoice for membership fees. Do not remit payment until then* I am a current CASS Member since I am a new CASS Member Please print the form using the PRINT button in the upper right hand corner. The form may then be sent via mail via fax or scanned and sent via email to Kath Rhyason Executive Director 1200 9925-109 Street Edmonton AB T5K 2J8 Fax 1-780-482-5659 email kath. rhyason cass. ab. ca --------------------------------------------------------------------------------------------------------------------------------------------Office Use Only Membership Register Number Notes Receipt Number. I am familiar with the the College of Alberta School Superintendents Professional Code of Conduct as presented on the CASS website at www. cass. ab. ca Name Last First Position Held Jurisdiction Email Address City/Town Province Work Phone Cell Signature Insert digital signature or print form and manually sign Postal Code Fax Date FEES Fees are due no later than October 31st. cass. ab. ca Name Last First Position Held Jurisdiction Email Address City/Town Province Work Phone Cell Signature Insert digital signature or print form and manually sign Postal Code Fax Date FEES Fees are due no later than October 31st. CASS membership fee is comprised of 250. 00 plus GST of 12. 50 for a total of 262. 50 GST Number - 10696 7052 RT PLEASE NOTE The jurisdiction will be sent an invoice for membership fees. CASS membership fee is comprised of 250. 00 plus GST of 12. 50 for a total of 262. 50 GST Number - 10696 7052 RT PLEASE NOTE The jurisdiction will be sent an invoice for membership fees. Do not remit payment until then* I am a current CASS Member since I am a new CASS Member Please print the form using the PRINT button in the upper right hand corner. Do not remit payment until then* I am a current CASS Member since I am a new CASS Member Please print the form using the PRINT button in the upper right hand corner. The form may then be sent via mail via fax or scanned and sent via email to Kath Rhyason Executive Director 1200 9925-109 Street Edmonton AB T5K 2J8 Fax 1-780-482-5659 email kath.

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