2 Application Form

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THEN – The Home Educators’ Network
Subscription / Renewal Form [circle one]

Membership renewals ($20) are due January 31 each year.
$20 paid in [ ] cash [ ] cheque :  [ ] receipt req’d     *Date: ..

Name:

Spouse’s Name:

Address:

City:

Phone:                                                             Mobile:

Email:

Child/ren’s Name  
1 

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2

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3

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4

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 BirthDate     HS’ed?

* Receive Newsletter by: [ ] mail/paper, or  [ ] e-mail (Adobe .pdf)

* Are you interested in attending …?
[ ] Swimsafe [ ] Family Fridays [ ] Subject Fairs eg Science Fair

* Would you like your names to be on a members’ directory? Yes / No

* Are you using a curriculum? Yes / No  If yes, which curriculum?
* Are you willing to be contacted by other home educators to discuss this curriculum? Yes /No

* I’d like to help with/ as /on (tick) :
[ ] Committee, [ ] Newsletter article, [ ] Newsletter Term Editor,
[ ] Activities

* I heard about THEN from: [ ] THEN-Waikato e-group
[ ] website  [ ] friends [ ] advert [ ] CAB [ ] other …

* Anything else? Any questions or comments?  

(THEN : 1. [  ] Treas.  2. [  ] Memb.Sec.   3. [  ] Co-ord.)

Please send completed form with cheque to :
THEN Subs, P O Box 20-257, Te Rapa, Hamilton. #

To print out, block between #…#, then print ’selection’.

Information collected here will only be used for THEN business purposes.

* Please join news/discussion e-group

* Go to THEN-Waikato e-group HOME