Company Membership Application

Membership Level: Company: First Name: Last Name: Job Title: Email: Home Phone: Home Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix Membership Region #1–Allegan, Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren #2–Hillsdale, Jackson, Lenawee, Monroe, Washtenaw #3–Wayne #4–Kent, Montcalm, Muskegon, Ottawa #5–Clinton, Eaton, Ingham, Ionia, Livingston, Shiawassee #6–Macomb, Oakland #7–Lake, Manistee, Mason, Mecosta, Missaukee, Newaygo, Oceana, Osceola, Wexford #8–Arenac, Bay, Clare, Gladwin, Gratiot, Isabella, Midland, Saginaw, Tuscola #9–Genesee, Huron, Lapeer, Sanilac, St. Clair #10–Antrim, Benzie, Charlevoix, Emmet, Grand Traverse, Kalkaska, Leelanau #11-Alcona,Alpena,Cheboygan,Crawford,Iosco,Montmorency,Ogemaw,Oscoda,Otsego,Presque Isle,Roscommon #12-Baraga, Gogebic, Houghton, Iron, Keweenaw and Ontonagon #13-Alger, Dickinson, Marquette and Menominee #14–Chippewa, Delta, Luce, Mackinac, Schoolcraft What is your age range? What gender do you identify with? If other, please specify: What race do you identify with? What ethnicity do you identify with? What region in Michigan do you live in? What region in Michigan do you work in? Would you consider the majority of the audience you teach: How would you describe your experience as an environmental educator? How many years have you been in MAEOE? Why did you join MAEOE? Please list any specific skills that you have which would be willing to share with MAEOE (Graphic design, accounting, etc.) Please list any specific expertise you have in the area of environmental science.