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NC TECH Non-Profit, Government + Education Membership Agreement
# of Full-Time NC-based IT Employees/Tech Enabled Membership Dues Amount
Please select
0-50 IT employees in NC/$750
51+ IT employees in NC/$1,500
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?
*
• NC TECH reached out to me
• I attended an NC TECH event
• I found NC TECH through an online search
• I found NC TECH on social media
• I read an article in the media that referenced NC TECH
• I was referred by (write in below)
• Other (write in below)
Hold CTRL key and select as many as applicable
Write in for referral or other
What is your motivation(s) for joining?
*
• Networking for Peer Interaction
• Networking for Sales Opportunities
• Visibility for My Business
• Public Affairs
• Talent Resources
• Professional Development
• Information Share
• Other (write in below)
Hold CTRL key and select as many as applicable
Write in for other
Company Information
Company/Organization
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Main Company Phone
*
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-
###
-
####
HQ State
*
Year Founded
*
Web Site
*
Twitter Handle
Total # Full Time
NC Employees
*
Total # Full Time
NC IT Employees
*
Business Categories
*
NC TECH offers a searchable online
Member Directory
. Review
Member Directory Categories
to determine which categories best describe your organization and type in above. To make additions or changes to your categories, email membership@nctech.org.
Company Description (optional)
Company Logo
Add File
Please include two logos:
JPEG or PNG
-AND-
EPS or AI
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.
Total Amount Due
Please complete total amount due based on annual dues investment plus optional Board of Advisor seat.
I have approval to join NC TECH
*
Yes
Not yet
Preferred Payment
Method
*
Credit Card (Complete secure form below) *
Invoice (Will be sent to primary contact and due upon receipt unless otherwise noted below)
Credit card info will be transmitted securely, but charged only after info is verified. A receipt will be sent to the email address you provide below.
Billing Instructions
If you have different/additional instructions for billing, please note them here
Name on Credit Card
First
Last
* Required with credit card payment
Credit Card Type
Please select
VISA
Mastercard
American Express
* Required with credit card payment
Credit Card Number
* Required with credit card payment
Security Code
* Required with credit card payment
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
*Required with credit card payment
Expiration Year
* Required with credit card payment
Billing Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
* Required with credit card payment
Email Receipt (or invoice) to:
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