NETS Telco/Carrier Registration TELCO/CARRIER REGISTRATION ($50/representative or 5 for $200) This form should be used by the ILECs, CLECs, Wireless, Cable companies. State Association Membership* PTA NYSTA Both Non-member Company/Contact InformationCompany Name* Name* First Last Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code RegistrantsRegistrations 1 - $50 2 - $100 3 - $150 4 - $200 5 - $200 $50/representative or 5 for $200Registrant #1 Name* First Last Registrant #2 Name* First Last Registrant #3 Name* First Last Registrant #4 Name* First Last Registrant #5 Name* First Last Payment InformationAll fees must be paid for by 9/22/23. Refunds will be issued for cancellations made by 9/22/23. No refunds after that date.Payment Method Check (send by 9/22/23) Credit Card (those paying by credit card will receive an invoice from PTA along with payment instructions) Checks should be made payable to: Pennsylvania Telephone Association Mail to: 30 N. Third Street, Suite 780, Harrisburg, PA 17101 Questions call 717-238-8311Total FeesTotal $0.00 NameThis field is for validation purposes and should be left unchanged.
