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NCPSMA is accepting dues for the 2008-2009 membership year. Please

print this page and mail with your dues payment ($20) to

NCPSMA, 630 Adams Ridge Road, State Road, NC 28676-9536

Name_________________________________________________________

(Individual memberships only- NO company-wide memberships accepted)

Address_______________________________________________________

City _____________________________ State ___________ Zip _________

Telephone ________________________ Fax _________________________

School System Name (LEA) ______________________________________

OR Company Name (Vendors)______________________________________

Membership Type _____ Regular _____ Retired _____ Vendor ________