NCPSMA 2011-2012 Membership Application

NCPSMA is accepting dues for the 2011-2012 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 ________ Associate

* Please list the name of your school system-Example: Alexander County Schools

**If not an employee of a school system list your company or group name on the next line-

Example: Company as B &D Boilers or Associate as DPI Plant Operation.

** Regular is someone currently employed in the maintenance department of a

 NC Public School System, Retired is someone retired from the maintenance

department of a NC Public School System, Vendor is a company or manufacturer

representative, Associate is everyone else.