Membership Application

Form Use: Membership Application or Member Information Update*

We would like to become a new member of ETEC.
I am updating the contact information for a current membership.

The initial membership payment should be submitted with the application. Dues are renewed annually (calendar year), and invoiced based upon the first month of membership. If joining as a corporate member, please include the names of the representatives from your organization who will attend meetings, as well as the email addresses for those individuals you wish to receive the weekly meeting notices and newsletters.

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

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 special events. You may opt out of these communications at any time by contacting info@eteconline.org.)

Membership Level*

Membership Level - Other Amount

Payment Type

Credit card payment - see below
Check will be mailed
Please email an invoice

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Recurring or One-Time Annual Payment

Please setup this payment to recur annually on this date.
One-time payment only.

Total Annual Recurring Dues

$0.00

Membership Application

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