ETEC – ETEC Membership Application with quarterly dues payments

Form Use: Membership Application or Member Information Update*

New member application
Existing member information update

The membership application is pending until the initial dues payment is received. Dues are renewed quarterly by automatic billing to authorized credit card.

Organization Name*

(If you are a student or retiree, please use last name, first name as the organization name.)

Administrative Contact

First Last

(This contact will receive details regarding the application and payment process.)

Administrative Contact Email

Administrative Contact to receive the weekly e-newsletter?

Yes
No

Primary Contact*

First Last

(This person will receive the weekly newsletter.)

Title*

Primary Email*

Phone*

Fax

Cell

Alternate Contact

First Last

Alternate Contact Title

Alternate Contact Email

Alternate Contact to receive the weekly e-newsletter?

Yes
No

Alternate Contact Phone

Organization Address (field labels are underneath the boxes)

Street Address Address Line 2 City State ZIP Code

Organization Description

(The description you provide will be used in ETEC's online membership directory and in one of ETEC's weekly newsletters to introduce you as a new member.)

Organization Website (go to website and copy link in browser- will include https://)

Company Logo

Max. file size: 512 MB.

Upload your company logo in jpg, gif, or png format. Maximum file size is 512MB.

Please send weekly e-newsletter to the following (not listed above)

Who will be attending the weekly meetings? (for name tag purposes)

Permission to publish contact information in ETEC's 'Members Only' online database (for Small Business level and above)

Yes
No

Your contact information will not be released beyond posting in the ETEC Membership Directory. Only ETEC members will be able to access this information. Also, as a member, you will receive ETEC's weekly e-newsletter and occasional emailed invitations to events or receive special notices. You may opt out of these communications at any time by contacting info@eteconline.org. ETEC does not share any personal information with 3rd parties.

Membership Level*

Student - Complimentary
Small Business - $750
Baseline Corporation - $1,500
Sustaining Corporation - $2,500
Corporate Partner I - $5,000
Corporate Partner II - $10,000
Other

Membership Level - Other Amount

Quarterly Payment Option requires valid credit card information

Credit card payment - see below

Credit Card

Card Details

Cardholder Name

Quarterly Payments

Please setup this payment to recur every three months

I understand that my credit card will be billed 1/4 of the annual membership dues amount quarterly until I cancel.

ETEC does not store credit or debit card information. (Your payment will be processed securely by Stripe, a U.S. company that allows businesses to accept payments over the Internet.)

Total Recurring Dues Payments

$0.00

ETEC Membership Application with quarterly dues payments

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