Annual Report for Member Group

Name of Member Group ________________________________________________________

Region ___________________

Name of Contact Person ________________________________________________________

Address ________________________________________________________________

Phone Number __________________ Email Address ____________________________

CEC Membership Number__________________________________________________

Name of Second Contact Person __________________________________________________

If this is a student group, please put advisor information here.

Address ________________________________________________________________

Phone Number __________________ Email Address ____________________________

CEC Membership Number __________________________________________________

Average number of members _______________________

Activities:

Additional Information / Documentation:*

We, the above named group, hereby request to be recognized as a regional member group of PACEC. We understand that an annual report will be submitted to the Membership Chair.

*Optional: You may include a list of officers, members, or any other documentation.

Send to: Dreamalee Brotz, Membership Chair

Plymouth Whitemarsh High School

201 E. Germantown Pike

Plymouth Meeting, PA 19462

E-mail: membership@pacec-sped.org

E-mail or Snail Mail accepted.