Job Title *

 Email Address *

Title
DR MISS MR MRS MS

First Name *

 Last Name *

Home Address *

 City *

State *

 Zipcode/Postcode *

Suite/Apt.

 Home Phone Number *

Work Phone and Extension *

 Work Fax Number *

School District *

 School Name *

Chapter No. *

Both National and State dues are required. Not all states participate in SDM program. Check SNA's website to see complete list.

National Membership Categories and Dues (Select only one)*

SN Employee

$28 Individual Membership
$28 School District Owned Membership (SDM)

Child Care Employee

$28 Individual Membership
$28 School District Owned Membership (SDM)

Student

$28 Individual Membership

 Retired

$28 Individual Membership

SN Manager

$30 Individual Membership
$30 School District Owned Membership (SDM)

 Child Care Manager

$30 Individual Membership
$30 School District Owned Membership (SDM)

District Director/Supv/Spec

$100 Individual Membership
$100 School District Owned Membership (SDM)

 Major City Director/Supv/Spec

$100 Individual Membership
$100 School District Owned Membership (SDM)

State Agency Director and Staff

$100 Individual Membership
$100 School District Owned Membership (SDM)

 Child Care Director/Supv

$100 Individual Membership
$100 School District Owned Membership (SDM)

Nutrition Educator

$100 Individual Membership
$100 School District Owned Membership (SDM)

 Other

$100 Individual Membership
$100 School District Owned Membership (SDM)

Affiliate Employee

$14 Individual Membership

 Affiliate Retired

$14 Individual Membership

If SDM, Name of Administrator:

 Administrator Phone Number

Employed by?

Public School
Private School
Private Management Company
CACFP

 Does your employer pay your dues?

Yes
No

Are you responsible for school nutrition operations in your school district?

Yes
No

SN Foundation (Funds/Scholarships for members)

$1
$5
$10
$15
Other

 SN Foundation (Funds/Scholarships for members) Total:

Political Action Committee (PAC)

$1
$10
$25
$50
Other

 Political Action Committee (PAC) Total:

Total Payment:
$

By checking this box acts as my signature and I verify that I have read and understand this application.*
Yes

Date *

Enter Word Verification in box below *