Membership Information Form

*Professional Number: * First Name: * Middle Name: * Last Name: Commonly Used Name:

Preferred Pronoun:

* License Level: * Mailing Address: * City/Town: * Province: * Postal Code:

* Home and/or Cell Phone: * Date of Birth: (respond with dd/mm/yyyy): * School/Home School:

*Contract Status: Permanent Probationary Term

* Position: Classroom Teacher Vice-Principal Principal Specialist

Can the NSTU contact you by text message? Yes No

If you responded yes to the question above, please indicate which phone number should be used for the text messages:

Can the NSTU share your phone number with a company contracted to provide telephone town hall services? Yes No

If you responded yes to the question above, please indicate which phone number should be used for town hall services:

Membership Information Form - Public Schools