To obtain an Enrichment Teacher’s Membership, you must be a current NETA-certified enrichment teacher in good standing.  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.

*First Name: 

*Last Name: 

*NETA Certification Number:

*Expiration Date of Current Certification: 

*Full Address: 

*City:                           *State:                  *Zip:

*Phone Number:               *Alt Phone:

*email:                           Website (if any):


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 $48 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 Enrichment Teacher Membership card and password.

Type of Credit Card:   Visa     MasterCard

* Card Holder’s Name:

* Billing Address:

* City:                      * State:          * Zip:

* Card Number: 

*Exp. Date:               CV2 #:


Terms of Agreement

This Enrichment Teacher 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: