NEAT Membership Application Today's Date?*Have you been a member of NEAT in the past?* Yes No Would you like to be on NEAT's mailing list?* Yes No I am already on NEAT's mailing list How did you hear about NEAT?*Contact InformationYour Name?*Your title/role?*Your organization?*Address of organization?*Your phone number?*Your email?*As a member, would you be the one requesting AT services?* Yes No Name of person responsible for requesting AT services?*Title/role of person who would request services?*The organization of person who would request services?*The phone number of person who would request services?*The email of person who would request services?*Billing InformationName of the person or department responsible for billing*Billing person's title/role?*The billing address?*Our annual membership fee is $1,100. How will this membership be paid?* Purchase Order Letter of Intent Cash, Check, Mastercard, Visa, or Discover Type in Purchase Order number*Upload a copy of the Purchase Order*Max. file size: 8 MB.Upload a Letter of Intent*Max. file size: 8 MB.
