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NCTApreneur Membership Information
Tech startups, meeting specific criteria, are eligible for a one-time $250 scholarship credit for the first year of membership. This scholarship is made possible by HQ Charlotte at Packard Place, an entrepreneurial hub based in Charlotte.
Please only complete this membership form if your Tech startup meets the following criteria:
• Company qualifies as an NCTA Technology Member (Predominant business is the development and/or sale of technology products or services)
• Company is headquartered in NC, and legally formed within the last 4 years.
• Company has 20 or fewer employees in NC.
Membership Category/
# of Full-Time NC Employees
*
Seat on the Board of Advisors
*
Please select
Yes = $600
Not at this time
Contact me to discuss
For info about this optional enhanced membership, visit: http://www.nctechnology.org/about/board_of_advisors.aspx
How did you hear about NCTA?
• NCTA reached out to me
• I attended an NCTA event
• I found NCTA through an online search
• I found NCTA on social media
• I read an article in the media that referenced NCTA
• 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
Is your company Founder/CEO interested in participating in a CEO Peer2Peer forum?
*
Please select
Yes
Not at this time
Contact me to discuss
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
Phone
*
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Year Founded
Web Site
*
Twitter Handle
Total # NC Employees
*
Must be less than 10 to qualify for special NCTApreneur rate.
Total # NC IT Employees
How many of your staff have a technical role?
Primary Industry
*
Please select
Accounting Services
Architectural and Interior Design
Associations and Societies
Audio Visual and Production
Business and IT Consulting
CleanTech
Computer Forensics
Construction
Data Centers
Defense
eCommerce
Economic Development and CHambers
Education
eLearning
Electronic Recycling
Energy
Entrepreneurial Services
Financial and Banking
Gaming and Simulation
Government
Hardware and Electronics
Healthcare
Hospitality
Human Resources and Employment
Insurance
International
Internet Releated Services
IT Security
IT Services
Leadership Development and Executive Coaching
Legal Services
Life Sciences
Manufacturing
Marketing and Public Relations
Mining
News and Media
Nonprofits
Office Furniture and Equipment
Other
Printing
Real Estate
Regional Development
Retail and Consumer Goods
Semiconductors
Software
Sports and Entertainment
Technical Documentation
Telecommunications
Trade Show Exhibits
Training
Transportation
Venture Capital
Secondary Industry
Please select
Accounting Services
Architectural and Interior Design
Associations and Societies
Audio Visual and Production
Business and IT Consulting
CleanTech
Computer Forensics
Construction
Data Centers
Defense
eCommerce
Economic Development and CHambers
Education
eLearning
Electronic Recycling
Energy
Entrepreneurial Services
Financial and Banking
Gaming and Simulation
Government
Hardware and Electronics
Healthcare
Hospitality
Human Resources and Employment
Insurance
International
Internet Releated Services
IT Security
IT Services
Leadership Development and Executive Coaching
Legal Services
Life Sciences
Manufacturing
Marketing and Public Relations
Mining
News and Media
Nonprofits
Office Furniture and Equipment
Other
Printing
Real Estate
Regional Development
Retail and Consumer Goods
Semiconductors
Software
Sports and Entertainment
Technical Documentation
Telecommunications
Trade Show Exhibits
Training
Transportation
Venture Capital
Company Description (optional)
Key Contact(s) Information
The primary contact is listed in the online directory and considered the key business contact for NCTA.
Primary Contact Full Name
*
Primary Contact Title
*
Primary Contact Email
*
Primary Contact Phone
*
The marketing contact is key to working with NCTA on visibility and engagement opportunities.
Marketing Contact Name
Marketing Contact Title
Marketing Contact Email
Marketing Contact Phone
All employees are eligible to receive member benefits and participate in NCTA activites. Please upload a list of employees to add to the database including: 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.
Payment
Method
*
Credit Card (complete secure form 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.
Name on Credit Card
*
First
Last
Credit Card Type
*
Please select
VISA
Mastercard
American Express
Credit Card Number
*
Security Code
*
Expiration
*
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
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