PLEASE READ BEFORE CONTINUING... Associate Membership is for businesses/organizations that have home/ main offices or some portion of their operations in Mississippi and which are predominantly engaged in the production, sale or rental of telecommunications equipment or consulting services. If your company/organization meets the above criteria, you may continue filling out this application. Otherwise, you may be eligible for the Regular Membership.I agree that I meet the above requirements for this type of membership.Company/Organization InformationOrganization Name *Principal Product/Service *Street Address *Apartment, suite, etcCity *State *ZIP / Postal Code *Primary (Non-Voting) RepresentativePlease designate one person from the company/organization to serve as the primary representative. This person will cast votes on behalf of the company/organization he or she represents.Name *Title *Email Address *Phone *Optional Alternate (Non-Voting) RepresentativeCompany/organization may designate one person to serve as the alternate representative. This person will cast votes on behalf of the company/organization he or she represents in the absence of the primary representative.NameTitleEmail AddressPhoneAnnual Dues InformationUpon approval of application and payment of annual dues, primary and one alternate will receive all correspondence from MCTA. By making application and paying annual dues, company/organization agrees to abide by MCTA bylaws.Annual dues are $120. Please send a check (payable to MCTA) to: MCTA 1501 W. Jackson Ave. Suite 113, Box 130 Oxford, MS 38655 MCTA Tax ID: eSignature *Please input your full name to digitally sign this application.SubmitPlease do not fill in this field. Please do not fill in this field.
