National Association of Test Directors
US Department of Revenue Taxpayer ID# 222659646

Name: Dr. Mrs. Ms. Mr. ________________________________

Title:____________________________________________________

Organization: ___________________________________________

Mailing Address:__________________________________________

City: __________________________________________

State:_________________ ZIP: ___________

Phone:_______________________

FAX: ________________________

E-Mail:_____________________________________(Please print clearly)

Check here if you wish to request that your directory information not be published on our NATD web site. ______

Membership Category: (please check one)

_____Active Member: Responsible for educational testing programs in settings not primarily for profit

_____Emeritus Member: Active NATD member for at least five years and no longer employed on full time basis

_____Associate Member: Not directly responsible for testing programs and/or involved in test development primarily for profit

Annual dues are $20.00; Please make checks payable to "NATD".

TREASURER:
Dr. George Olson
Director - Center for Public School R&E
Appalachin State University - LES
Boone, NC 28608

Phone:(704) 262-2764 Fax: (704) 262-2128
EMAIL: olsongh@appstate.edu