NEOCA Membership 2022:
January 1, 2022 to December 31, 2022
Instituition / Agency Grantee
*
Name of EOC Project
*
Contact:
*
First Name
Last Name
Title:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Registration
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EOC Institutional Membership
This membership includes 2 votes at the NEOCA 2022 business meeting and qualifies your program participants to apply for the NEOCA Scholarships 2022
$
100.00
Affiliate Membership
This membership is for non-EOC program personnel and does not include voting rights at the NEOCA business meeting but does qualify your program participants for the NEOCA Scholarship.
$
75.00
Note
You can submit the form ahead of payment if payment cannot be made until after September 1. The form will let us know to expect your check or payment via PayPal and will “hold” your membership until payment is received. Mail checks to NEOCA Matthew Donovan, Treasurer 217 McKnight St Ashland, KY 41102
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
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