<%@LANGUAGE="VBSCRIPT"%> <% Dim dthisDate dthisDate = Now() %> :: MiCTA - Technology Solutions for Non-profit Organizations ::
(888) 870-8677
(989) 772-2623
info@micta.org
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Major Collaborators:

Novastor, InfoCore and MiCTA are working together to offer you a FREE 1 year MiCTA membership. Please fill out the following form and click 'submit', or print the form and fill out, then fax to the number below.


MiCTA/ATAlliance
1500 W. High St.
Mt. Pleasant, MI  48858  
Voice (888) 870-8677
Fax (989) 772-3239  
membership@mictaservice.com

MiCTA/ATAlliance Member Application Form

Non-Profit Organizations shall pay annual fees of seventy-five dollars ($75.00), allowing up to five individual contacts at your organization to be registered with MiCTA..
Please complete the following information:
Organization Name:
Primary Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Organization Internet URL:
Check here if you would like to be added to the MiCTA/ATAlliance ListServ
Institutional Information
Please indicate relative size of your organization:     
Enrollment   Employees  
       
0-1,499 1,500-4,999 5,000-11,999 12,000-up
Please identify your main line of business that most closely represents your organization
College & University K-12 Government/Public Sector
Healthcare Library Other
 
Click here if you have no more contacts, or continue scrolling to add more.
Second Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Check here if you would like to be added to the MiCTA/ATAlliance ListServ
Click here if you have no more contacts, or continue scrolling to add more.
Third Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Check here if you would like to be added to the MiCTA/ATAlliance ListServ
Click here if you have no more contacts, or continue scrolling to add more.
Fourth Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Check here if you would like to be added to the MiCTA/ATAlliance ListServ
Click here if you have no more contacts, or continue scrolling to add more.
Fifth Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Check here if you would like to be added to the MiCTA/ATAlliance ListServ
Please identify any additional personnel responsible for the following areas if not identified above.
A.  Telecommunications
B.  Budget/Finance
C.  Video Network/Equipment
D.  Computer Services/Info Tech
E.  Purchasing
F. LAN/Data Network
Survey Information
What is your primary reason(s) for joining MiCTA/ATAlliance?
How did you hear about MiCTA/ATAlliance?
Are you a current member of or represented by any of the following organizations?
ACUTA MHEC
NEBHE SREB WICHE
Annual Associate Dues
Novastor and MiCTA have teamed up to offer you free membership for 1 year.  Hereafter, annual dues of $75.00 will be invoiced within two weeks of your anniversary date.

Fax:(989)772-3239
Phone: (888)870-8677
E-Mail: membership@mictaservice.com

MiCTA/ATAlliance
1500 W. High St.
Mt. Pleasant, MI 48858
Attn: Clancy DeLong

 

 

 
 
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