The Horace Mann League of the USA  
Membership Application Form

The Horace Mann League exists to:

1. Perpetuate the ideals of Horace Mann.
2. Preserve and support quality public schools.
3. Preserve the separation of church and state.



Mr. Mrs. Ms. Dr. _________________________________________________

Address ________________________________________________________

City ______________________ State _____ Zip _______________________

Work Phone ( ) _____ _________ FAX ( ) _____ _____________

Internet e-mail ______________________ @ ___________________________

Position _________________________________________________________

Your highest degree was earned at (Name of university)____________________

Nominated by (optional) _____________________________________

Annual Dues: $65.00 (Federal ID: 52-6054490)

Make check to:
The Horace Mann League of the USA
560 Rainier Lane
Port Ludlow, WA 98365


If payment by credit card: American Express __ , Master Card __ , or Visa __.

Account No. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp. Date ____

Signature required ___________________Phone (_ _ _) __ __ __-__ __ __ __


Mail to: The Horace Mann League of the USA
Dr. Jack McKay, Executive Director
560 Rainier Lane
Port Ludlow, WA 09365

Email: jmckay@hmleague.org
FAX (866) 389 0740
Phone (360) 437 1186


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