A Program Providers Membership is granted to an organization, company or entity which provides enrichment classes or programs to children/minors.  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.

*Name of Organization: 

*Full Address: 

*City:                            *State:                 *Zip:

*Phone Number:             *Fax:

*Company email:             *Website:


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

Enrichment Company                        Summer Day Camp

PTA / PTO                                       Sleep-away Camp

Park & Rec Department                     Private Studio (Dance, Karate, Arts, etc.)

Community Center                            Daycare Center

City-operated Enrichment Program      School Aftercare/Yard Program

YMCA                                             Other


If you marked “Other”, please describe:


* Contact Person: First name      Last name  



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 Program Providers 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: