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Membership Application
Note: Membership dues are assessed annually in accordance with the categories noted. Please check your membership preference and complete the information below.
Membership Options
Corporate
- $200: Entitles member to four employee designates on the GTEDC, with the option to add additional members at the rate of $50 per member.
Business/ Individual
- $75: Entitles member to one employee designate on the GTEDC, with the option to add additional members at the rate of $50 per member.
Educational, Non-Profit, Association
- $75: Entitles member to one employee designate on the GTEDC, with the option to add additional members at The rate of $50 per member.
Student/Retired
- $50: Entitles (one) individual on the GTEDC.
Membership type
*
Corporate
Business / Individual
Educational
Student / Retired
Name
*
First
Last
TItle
Company Name (if applicable)
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Enter Email
Confirm Email
Do you have a website?
*
Yes
No
Website Address
Corporate Designated Members
Designated Member #1
Name
Title
Designated Member #2
Name
Title
Designated Member #3
Name
Title
Designated Member #4
Name
Title
Included Designated Member
Designated Member
Name
Title
Additional Members
Would you like to purchase additional members for $50 each?
Yes
No
How many additional members would you like to purchase?
*
Additional Members Cost
Price:
$0.00
Please enter the names (and titles) of your additional designated members.
Payment
Total
$0.00
Credit Card
*
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Supported Credit Cards: Discover, MasterCard, Visa
Card Number
Month
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05
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Year
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Expiration Date
Security Code
Cardholder Name
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Description
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Date