ASSOCIATES MEMBERSHIP

An 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

PTA / PTO Organization                     Private Studio (Dance, Karate, Arts, etc.)

Public Servant / Legislator                  Daycare Center

Park & Rec Department                     School Aftercare/Yard Program

Community Center                            Association

City-operated Enrichment Program      Other

                                                         
If you marked “Other”, please describe:

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.
Type of Credit Card:   Visa     MasterCard

* Card Holder’s Name:

* Billing Address:

* City:                         * State:         * Zip:

* Card Number: 

*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: