NETA  13428 Maxella Avenue #436  Marina Del Rey, CA  90292  (310) 827-8827  NetaCertified@aol.com

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PROGRAM PROVIDERS' ASSOCIATE'S MEMBERSHIP

To obtain a Program Providers’ Associate’s Membership, you must own, operate or be affiliated with an organization, group, venue or facility which provides enrichment classes and programming.  Please fill out the information requested below and press “submit”.  Within one week, you will receive a username and password via email which will give you access to the NETA-certified Enrichment Teachers Database:

Fields marked with a * are required.

*First Name:   

*Last Name:

*Organization:

*Please mark the appropriate box or boxes which best describe you/your organization:

Enrichment Company

PTA / PTO

Parks and Recreation Department

Community Center

City-operated Enrichment Program

YMCA

 Summer Day Camp

Sleep-away Camp

Studio (Dance, Martial Arts, etc.)

Daycare Center

School Aftercare/Yard Program

Other

If you marked "Other", please describe:

*What is your position within your organization?:

Owner

Director / manager

Contact person

Human resources director

*Mailing Address Line 1:

Mailing Address Line 2:

*City:   *State:   *Zip:

*Phone number: Fax number:

*Email address:

 

Payment Information

If you are paying by check, please print this page out with the completed information and include a check in the amount of $34.00 made payable to NETA, Inc..  Mail to:  NETA, 13428 Maxella Ave. #436  Marina Del Rey, CA 90292.  Once your application and check have been processed, NETA will mail you your Associate’s Membership password and welcoming materials.

Type of Credit Card: Visa MasterCard

*Card Holder's Name:

*Billing Address Line 1:

Billing Address Line 2:

*City:   *State:   *Zip:

*Card Number: *Expiration Date: /

Terms of Agreement

This Program Providers' Associate's Membership can be renewed annually and is valid for a period of one calendar year (starting January 1 and ending December 31).  This is a membership only and the National Enrichment Teachers Association, Inc. does not endorse, accredit or guarantee the work of the bearer of this membership.  Deliberate misuse of this membership (i.e. fraud, misrepresentation, solicitation for private gain) is prohibited and can result in suspension of and/or revocation of membership privileges.

I agree to have my credit card charged in the amount of: $34.00.

*Initials: *Date:

 

    

 

NETA 13428 Maxella Avenue #436 Marina Del Rey, CA 90292 (310) 827-8827 NetaCertified@aol.com

All material © 2005 National Enrichment Teachers Association, Inc.