ASSOCIATES MEMBERSHIPAn Associates Membership is granted to individuals or organizations affiliated with the culture of enrichment through programming, legislature or association. Please fill out the information requested below. Once your application has been processed, your membership will be active. (Please allow 2 weeks for processing). Fields marked with a * are required. * Applicant First Name: * Applicant Last Name: Name of Organization (if any): *Full Address: *City: *State: *Zip: *Phone Number: *Alt Phone: *email: Website (if any):
*Please mark the appropriate box or boxes which best describe your organization: Interested Parent YMCA School District Enrichment Program
Private School
Summer Camp Public Servant / Legislator Daycare Center Park & Rec Department School Aftercare/Yard Program Community Center Association City-operated Enrichment Program Other
Payment Information To pay by credit card please fill out below. If you are paying by check, please print out this page with the completed information and include a check in the amount of $78 made payable to NETA, Inc. Mail to: NETA Memberships, 13428 Maxella Ave. #436, Marina Del Rey, CA 90292. Once your application and check have been processed, NETA will mail you your Associates Membership card and password. * Card Holder’s Name: * Billing Address:
* Card Number: text box *Exp. Date: CV2 #:
Terms of Agreement This Associates Membership is valid for one year from the date of processing and can be renewed annually. This is a membership only and the National Enrichment Teachers Association, Inc. does not endorse, accredit, certify or guarantee the work of the bearer of this membership. Deliberate misuse of this membership (i.e. fraud, misrepresentation, solicitation for private gain, etc.) is prohibited and can result in the suspension of and/or revocation of membership privileges. *Initials: *Date:
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