Georgia Civic Engagement Honor Society Membership Registration

Georgia Civic Engagement Honor Society
Membership Registration

Your Information

First Name

Last Name

Gender

Race/Ethnicity

Phone

Email

Street Address (Include Apt. number)

City

State

Zip Code

Country

School Name (No abbreviations)

Membership Options

Please choose your membership level

GISA Member School ($30)Public School ($25)

Civic Engagement Information

Describe one of your community service or civic engagement experiences and the impact it had on you.

Why is an informed and engaged citizen important for the success of our democratic republic?

I plan to vote when I am eligible

YesNoUnsure

I plan to volunteer in my community as an adult

YesNoUnsure

I certify that I have met the qualifications for the Georgia Civic Engagement diploma seal as outlined by the Georgia Department of Education.

Yes

Payment Information

Payment Method

Credit CardMail in Check (Mail to: PO Box 3789, Cartersville GA 30120)

Name on Card

Billing Email

Card Number

MM

YY

Code

Contact Information