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?* Type of annual membership?* Individual Provider - $150.00 Group/District/Agency - $500.00 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.