Associate Member Application

Associate Member Application

Membership Eligibility
PLEASE READ BEFORE CONTINUING...

Associate Membership is for organizations that have home or 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 critiera, you may continue filling out this application. Otherwise, you may be eligible for the Regular Membership.

Regular Member Application

Primary Representative
Primary Representative

Please designate one person from the company/organization to serve as the primary representative. This person will receive all MCTA correspondence.
Name*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Regular Member Application

Alternate Representative
Alternate Representative (Optional)

Company/organization may designate one person to serve as the alternate representative. This person will also receive all MCTA correspondence.
Name

First NameLast Name
Title
Email
example@example.com
Phone Number
Please enter a valid phone number.

Regular Member Application

Annual Dues Information
Upon 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
E-Sign*

Clear
Should be Empty:

Regular Member Application