PATS   c/o Technology Education   P.O. Box 6122   509 Allen Hall   West Virginia University   Morgantown, WV 26506     E-Mail: pats@wvu.edu  Phone: 304/293-4696, 296-9333

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Please complete this form and return to us, with a check or money order in the amount of $20.00, payable to PATS. Do not send cash.

Name:__________________________________________________________________________

Home Address:_____________________________________    Phone:_______________________

City:__________________________________   State:_____________      Zip:_________________

Work Address:_____________________________________    Phone:_______________________

City:__________________________________   State:_____________      Zip:_________________

___________________________________    http://______________________________________
E-Mail Address                                                     Web Page Address

Program (Ed.D. or MA) and Concentration:______________________________________________

Brief description of your areas of academic/technical specialization and interest:

________________________________________________________________________________

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Please select at least one committee from the list below on which you would like to work.   (Click here for descriptions.)   There are lots of ways to contribute to PATS activities.

___Presentations Committee      ___Social Committee      ___Communications Committee

Please check one:         ___ New Member         ___ Membership Renewal