Member Group Recognition
Name of Member Group ________________________________________________________
Region ___________________
Name of Person
Submitting Application
_____________________________________________
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
__________________________________________________
Anticipated number of members
_______________________
Brief Description of Activities:
*Optional: You may include a list of officers, members,
or any other documentation.
Send to: Dreamalee Brotz, Membership Chair
201
E-mail: membership@pacec-sped.org
E-mail or Snail Mail Accepted