Name:

Phone:

School District:

Address:

City: State:

Zip:

e-mail address:

$_________ Membership $12.00
$_________ Resource Guide for the Gifted $10.00 (includes local resources, Library List, Information Sheet List)
$_________ Tax deductible contribution to scholarship fund

Total Enclosed: $

Mail to GEAR, P O Box 15034, Reading PA 19612-5034

Rev. 2/2000

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