A Network Connecting School Leaders From Around The Globe
Keany Associates, Inc. | email@example.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
 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.
 ORGANIZATION INFO
NAME OF ORGANIZATION: __________________________________________________
OFFICE #: __________________________ CELL#__________________________________
E-MAIL ADDRESS: ___________________________________________________________
I’d like to _JOIN at _ RENEW at _ EXTEND at _UPGRADE to the Membership level
 MEMBERSHIP CATEGORY:
_ Individual $19.95
_ Organization > 20 members $15.95/member
_ Organization > 100 members $12.95/member
 PAYMENT INFORMATION:
Please mail or e-mail your application and appropriate payment to:
School Leadership 2.0 Membership
5 Pinewood Drive,
Huntington, NY 11743
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.
_ I have enclosed my check for $ payable to Keany Associates, Inc.
_ Purchase Order:
Contact Person: _________________________________________
(Please enter your name above)
Purchase Order #: _______________________