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Educator
Membership
Application Form
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Print this application,
complete the form, and mail or fax to the address stated below.
Contact Information:
| First Name: |
Last Name: |
Middle Initial: |
| Mailing
Address: |
| City: |
State/Province: |
Postal Code: |
| School
or College Name: |
|
Title:
|
| Email
Address: |
| Web Site
Address: http:// |
| Phone: |
Fax: |
Other: |
| How
did you hear about the ARC Network? |
Company Information:
| Current
number of classes per year: |
|
Short Description
of your School or College:
|
Dues:
| Annual
Dues: |
$ 450 |
| Set
Up Fees (one time charge) |
$ 50 |
| TOTAL |
$ 500 |
Payment Type:
| Pay By
Check: |
Check
#: |
Amount:
$ |
| Pay By
Credit Card (circle one): |
MasterCard: |
VISA: |
| Credit
Card Number: |
| Expiration
Date: |
Name
on Credit Card: |
| Billing
Address: |
| City: |
State: |
Zip: |
Instructions:
To process and
qualify your application for membership, please include the following on floppy
disk or send via email:
- School, College or Organization
Logo (.gif or .jpg file format preferred or we can scan hard copy photos
or logos)
- Please send us a brochure
or any information you have describing your school, college or organization.
An ARC Network representative will call you regarding setting up your web
page and advertising.
Mail or FAX this application
along with the above information and your yearly dues to the following address:
The ARC Network
118 Lake Street South, Suite G
Kirkland, WA 98033
FAX:
(425) 284-2833
Email: arc@accidentreconstruction.com
After review
by the membership committee, you will be notified of your membership status,
be entered in the ARC Network Educator Directory, and your membership package
will be sent to you. All memberships are processed on the last day of each month.
I certify
all the above information is true, correct and complete to the best of my knowledge.
I authorize the ARC Network to verify the above information and charge my credit
card (if paying by credit card).
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_________________________________
(signature)
|
_________________________________
(date)
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Return
to membership information
Return
to the ARC Network Home Page
