2022 TETA Corporate Membership Application

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Tennessee Educational Technology Association
Application for Corporate Membership
October 2021- December 31, 2022

CORPORATE MEMBERSHIP (up to 4 State- Wide Members) ($500.00)

This gives your company membership in TETA. ETETA, MTETA and WTETA

Membership Contact Information

This is your contact information. Billing contact information is listed below. If this information is the same, please check the box below.

Company Name *

Company Website *

Does Your Company have a E-Rate SPIN number? *

Please input SPIN number below. If you are a non E-rate vendor, please respond with (N/A).

Address *

City *

State *

ZIP *

Phone *

(xxx) xxx-xxxx

FAX *

(xxx) xxx-xxxx

Representative 1

Email 1

Representative 2

Email 2

Representative 3

Email 3

Representative 4

Email 4

Representative 5

Additional Representative @ $100.00

Email 5

Representative 6

Additional Representative @ $100.00

Email 6

Non-refundable/non-prorated membership amount (payable to TETA)

Corporate Membership ($500.00)

If you are paying by check, you will receive an invoice from Treasurer@teta.org. Please send check with a copy of the invoice or PRINT and SEND completed application and non-refundable membership amount to:

Tennessee Educational Technology Association
c/o Melony Surrett, Treasurer
Post Office Box 261
Johnson City, TN 37605

A la Carte Options--TETA Membership is required to add A la Carte options -

Regional ITA - $1,500 (all regions)

Session only at ATA -- $1,500 (all regions)

Session only at ITA -- $500/each region

Check this if you want ATA or ITA option above for WTETA Only

Check this if you want ATA or ITA option above for MTETA Only

Check this if you want ATA or ITA option above for ETETA Only

Clear selection

Check

CK#

Credit Card

If you mark this option, your invoice will be emailed with instructions for using Square with your credit card to pay the invoiced amount of membership. There will be a surcharge of 3% for using a credit card.

Credit Card

Billing Info

If billing information is the same as contact information, please check below and do not fill out the rest of this form.

SAME

Bill To: *

ie: Account Payable

Company *

Address1 *

City1 *

State1 *

ZIP1 *

Phone of billing contact *

(xxx) xxx-xxxx

FAX1

(xxx) xxx-xxxx

Email of billing contact *

Submit

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