PLEASE READ BEFORE CONTINUING... Regular membership is for an organization that contains users of telecommunications technology and/or services and which meet the following criteria: Organization's home or main office or some portion of their operations is located in Mississippi. Organization is not predominantly engaged in the production, sale or rental of telecommunications equipment or consulting services. Subsidiaries or affiliates of these companies that are not primarily engaged in furnishing the foregoing services may be eligible for membership. If the organization is a subsidiary of another company and their communication services are sufficiently extensive and essentially distinct from those of their parent company, it can qualify for separate membership. If your company/organization meets the above criteria, you may continue filling out this application. Otherwise, you may be eligible for the Associate Membership.Please check the box below if you meet the above requirements. *I agree that I meet the above requirements for this type of membership.Company/Organization InformationOrganization Name *Industry *Street Address *Apartment, suite, etcCity *State *ZIP / Postal Code *Primary (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 (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 $85. 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.
