NRTCTA Membership Application 

New & Renewal  2009-10

Northeast membership year is July 1 through June 30!!
 

Name: _______________________________Title: _______________________

Telephone number: _____________________FAX number: _________________

E-mail: __________________________________________________________

Address: _________________________________________________________

Name of Community you work for: _____________________________________

Dues:   US$ 30.00 Active Member (Also for Each Vendor Representative)

$   5.00 Retired Member

$100.00 Subscribing Member Firm 

Associate Business Membership

$100.00 Annual Dues           

Name of Company: __________________________________________________ 

Representative Name/Title:  ___________________________________________ 

Telephone number:  ________________________FAX number:  ______________ 

E-mail:  ___________________________________________________________ 

Address:  __________________________________________________________ 

               __________________________________________________________ 

Make check payable to: NRTCTA

Send to:  NRTCTA, c/o Vikki Fogg, CTC
Membership Chairperson
41 Main Street
Meredith, NH  03253
Phone (603) 677-4202   Fax (603) 677-1090
vfogg@meredithnh.org

Associate Business Membership
$100.00 Annual Dues

Membership dues must be paid prior to attending the Annual Conference.  
 

Name of Company:        ___________________________________

Representative Name/Title: _________________________________

Telephone number: ________________

FAX number: _____________________

E-mail: ________________________________________________

Address: ______________________________________________

              ______________________________________________

Make check payable to: NRTCTA

Send to: