WVSBA Membership Directory Information

Using the form below, please provide the WVSBA staff with the specified directory information, returning the form to the WVSBA staff. Please note that this information is considered confidential association-related information, and will not be released to the news media, vendors/sales persons or for other similar uses. Copies, however, of the WVSBA Membership Directory will be provided to the State Superintendent of Schools, legislative staff members, the governor’s office and similar entities. Thank you.

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Title:    Mr.  Ms.  Mrs.  Dr.

Name: *

Nickname:

Year Term Expires:

County:

Preferred Mailing Address:

Home Phone: *	Work Phone:
Preferred Fax:	Email: *

Check if:

Board President

Board Vice President

In what form do you prefer to receive WVSBA communications/publications?
(WVSBA recommends receiving communications electronically)

Electronic (e.g, e-mail, Internet)     Hard Copy     Both

Signature: *

Date: *

*Required fields

If you are having problems submitting this form or do not have an email address please call Shirley Davidson at 304.346.0571