Tesol ukraine membership 2010 Teachers of English to Speakers of Other Languages in Ukraine icon

Tesol ukraine membership 2010 Teachers of English to Speakers of Other Languages in Ukraine




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НазваTesol ukraine membership 2010 Teachers of English to Speakers of Other Languages in Ukraine
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recent photograph

here, (for those who did not sent in 2009)

Page1 of 4



TESOL - Ukraine membership 2010

Teachers of English to Speakers of Other Languages in Ukraine

http://tesol-ukraine.at.ua


First and Last Name in English,city/oblast, telephone number(s)

_________________________

прізвище, ім’я, по-батькові українською мовою

____________________________

повна чітка адреса українською мовою, на яку надсилатимуться друковані матеріали:



TESOL-Ukraine member since (year)|

new member



First and Last Name in English, e-mail

_______________________


______________________


Previous and |or current position in TESOL-Ukraine



1. Name (Please write your complete name in Latin letters, EXACTLY as it appears in your foreign passport)


______________________ ________________ _____________

Last Name First Name Title (If Candidate of Sciences or Doctor of Sciences)



2. Date of birth / /

day/month/year




3. Place of birth

city/country

4. Citizenship (You must be a citizen of Ukraine):




5. Institution name /Contact Address


Institution Name:

Department:



^
6. Home Contact Address

Street, Building number, Apartment


Street, Building number, korpus





City Index


City Index





Home telephone (include city code)


Mobile number:_________________________


Work telephone, fax

e-mail address: ______________





e-mail address:

Page 2 of 4

^ 7. Your Current Position and Title: __________________________________________________________________

8. Work experience, including previous positions and titles. Use additional space if necessary.

Years

Position and Title

Institution and City

Responsibilities

























^ 9. Education, Academic and Professional Training, including degrees earned and fields of specialization

Institution and City

Years attended

Field of Study

Degree earned













^ 10. Previous travel and study or research experience in the U.S., UK or other foreign country:

Dates


Purpose of Visit

Program











^ 11.Active Professional Membership(s):


11. Short list of recent publications:


12. (optional ) On a separate sheet of paper, please explain why you want to be a TESOL-Ukraine Leader, what are the ways to improve the organization, what position you would like to take in order to put your ideas into life, what info should be put on the website of the organization etc.


Date : _________________________ Signature : __________________________________________


^ Send your application package and the copy of the receipt (the details are on the fourth page) on fee payment by e-mail to the following address: tesol-ukraine@list.ru

Page 3 of 4 Appendix to

TESOL-Ukraine annual membership application

Joint membership

^ MEMBERSHIP LIST

City/village, oblast____________________________Coordinator_______________________





First and Last Name in English

та прізвище, ім’я, по-батькові українською мовою





Contact Information

(telephone number, e-mail)

1.












2.












3.












4.












5.












6.












7.












8.












9.












10.













Your membership is valid for a year since the date of your payment (the membership payment details are on the last page)



Coordinator_______________________


Date ____________________


Signature ____________________


^ Send your application package and the copy of the receipt (the details are on the fourth page) on fee payment by e-mail to the following addresss: tesol-ukraine@list.ru

Send your application package and the copy of the receipt on fee payment by e-mail to: tesol-ukraine@list.ru

In five business days you will receive the confirmation of including your data into TESOL-Ukraine database (Your private information will be used for sending you educational materials and for TESOL-Ukraine purposes only!)

NOTE:

In case you have no possibility to send your photo and the copy of the receipt by e-mail, please do it by regular mail to the following address:

Миколайчук Аліса Іванівна

пр-т Грушевського 50/ 84

м. Кам’янець-Подільський

Хмельницька обл..

Україна

32300


^ The individual TESOL-Ukraine membership fee (four Forum magazines, ) : 90 UAH

The group (not more than 10 people) TESOL-Ukraine membership fee (four Forum magazines per group , participation at TESOL-Ukraine events for less payment for every member ): 360 UAH

Your membership is valid for a year of 2010 since the date of your payment


Внески Асоціації викладачів англійської мови «ТІСОЛ-Україна» сплачуються у відділеннях Приватбанку.

За послуги додатково потрібно сплатити 0,75% від суми платежу.

http://www.privatbank.com.ua/title.html

(you can find in their menu line “филиалы» and then your city with all the addresses)


Please , do take a copy of the bank requisites with you when you go to pay.

The payment is taken only in Privat Bank offices

The bank requisites:


Реквізити поповнення карткового рахунку

Банк: ПриватБанк

р/р 29243825510602

МФО 315405

ЗКПО 22772795

В призначенні платежу вказати: благодійний внесок

НОМЕР КАРТИ 6762 4620 3851 8095


Please save your fee payment receipt!


Send your application package by e-mail to the following addresss: tesol-ukraine@list.ru




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