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Annual Dues

$10.00

NCETA Membership Application

Name: _______________________________________________

Position: _____________________________________________

Agency: ______________________________________________

Address: _____________________________________________

City _____________________ State ______  Zip _____________

Phone: __(_____)______________________________________

Fax : __________________ E-mail: _______________________

                                      Region: _________________ County ______________________

                                      New Member __________                      Renewal ____________       

Send Registration Form & Payment to:

Willi am L. Wooten, NCETA
C/O WDTC
101 Tarboro Street
Rocky Mount , NC 27801
Phone: (252) 977-3292
Fax:  (252)985-4438
 

Membership Year 4/1/10 -3/31/11  ______

Membership Year 4/1/11 -3/31/12  ______

     

              

 

 

 

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