Keany Associates, Inc. | keanymichael@gmail.com | T: 631.828.9100

5 Pinewood Drive, Huntington, NY 11743

SCHOOL LEADERSHIP 2.0 is a professional learning community for educators from around the globe!

SCHOOL LEADERSHIP 2.0

ORGANIZATIONAL MEMBERSHIP FORM

[1] OUR PROCESS:

STEP 1: Complete this form, sending payment, and a current list of your membership. Your list should include the name, email address, position and school of each member.

STEP 2: Upon receipt of this form, we will contact you via e-mail to confirm your group membership. The confirmation e-mail will include an invite link that you can send to your membership.

STEP 3: Members should use this link to sign-up for School Leadership 2.0. As the members of your organization sign-up we will reference the list you sent us. Please notify us of any changes.

[2] ORGANIZATION INFO

NAME OF ORGANIZATION: __________________________________________________

MAIN CONTACT:

NAME: ____________________________________________________

OFFICE #: __________________________ CELL#__________________________________

E-MAIL ADDRESS: ___________________________________________________________

I’d like to _JOIN at _ RENEW at _ EXTEND at _UPGRADE to the Membership level

checked below,

[3] MEMBERSHIP CATEGORY:

Individual Membership

_ Individual $19.95

Organizational Membership

_ Organization > 20 members $15.95/member

_ Organization > 100 members $12.95/member

[4] PAYMENT INFORMATION:

Please mail or e-mail your application and appropriate payment to:

School Leadership 2.0 Membership

5 Pinewood Drive,

Huntington, NY 11743

E-mail: keanymichael@gmail.com

PAYMENT IS FOR ONE YEAR. IT IS THE RESPONSIBILITY OF THE ORGANIZATION TO PROVIDE

UPDATES OR CHANGES TO THEIR MEMBERSHIP ROSTER. IF YOU THINK YOUR

ORGANIZATION MAY GROW, PLEASE CONSIDER ADDING SOME EXTRA MEMBERSHIPS.

_ Check:

_ I have enclosed my check for $ payable to Keany Associates, Inc.

_ Purchase Order:

Contact Person: _________________________________________

(Please enter your name above)

Organization Name:_____________________________________

Purchase Order #: _______________________

Total: $___________________________________