NCETA Application

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MEMBERSHIP DUES:

_____ $20  Individual Membership

_____$150 Lifetime

MEMBERSHIP TYPE: _____ New Member _____ Renewal

MEMBERSHIP YEAR:  _____2016-17 _____ 2017-18

NCETA Membership Application

Name: _______________________________________________

Position: _____________________________________________

Agency: ______________________________________________

Address: _____________________________________________

City _____________________ State ______  Zip _____________

Phone: __(_____)______________________________________

Fax : __________________ E-mail: _______________________

Region: _________________ County ______________________

New Member ________  Renewal ______  Fiscal Year ________

Send Registration Form & Payment to:

Nancy Landis
NCETA
P. O. Box 1883
Asheboro, NC 27204

     


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