EmailMe Form - Current - Prof Services Membership Agreement

# of Full-Time NC Employees/Professional Services Membership Dues Amount

Please select the appropriate headcount range and dues amount from the menu. *Note: Membership is by organization, not individual.

Please add a Board of Advisors Seat:

I'm ready to join the Board of Advisors - activate my seat and process the $600 Advisor dues along with my membership dues

I'm interested, but I have some questions - please contact me to discuss

Not at this time

(See Advisors program description, fee and current roster HERE)

If adding Board of Advisor:
Advisor Name/Job Title

How did you hear about NC TECH? *

Hold CTRL key and select as many as applicable

Write in for referral or other

Primary Contact Information

The primary contact is considered the key business contact for NC TECH and listed in the online member directory.

Primary Contact Name *

Title *

Email *

Phone *

Key Contacts

If applicable, please add these additional business contacts who we can engage in membership activities:

Billing Contact Name (if should be different than Primary)

Title

Email

Phone

Marketing Contact Name

Title

Email

Phone

CIO or IT Contact Name

Title

Email

Phone

CISO or Security Contact Name

Title

Email

Phone

HR or Talent Acquisition Contact Name

Title

Email

Phone

Community or Government Affairs Contact Name

Title

Email

Phone

All employees are eligible to receive member benefits and participate in NC TECH activities. Please upload a list of employees to add to the database to ensure they receive a welcome, member portal login and email communications (include Name, Title, Email, and Phone).

Employee List
(optional)

Payment Information

Total Amount Due

Please complete total amount due based on annual dues investment plus optional Board of Advisor seat.

Preferred Payment
Method *

Credit Card (Complete secure form below) *

Invoice (Will be sent to primary contact and due upon receipt unless otherwise noted below)

Billing Instructions

If you have different/additional instructions for billing, please note them here

Name on Credit Card

First Last