Nebraska Independent Telephone Association

~ APPLICATION ~

We appreciate your interest in an Associate Membership with the Nebraska Independent Telephone Association. Your support of the association will be much appreciated and a link to your business will be located on this website.

Membership Dues for year: 7-2012 thru 6-2013: $25 per year

Submitting this form notifies NITA of your interest in membership.  Please mail your membership dues to:

   Nebraska Independent Telephone Association
   C/O Klint Arnold, Treasurer
   112 S 5th St., PO Box 113
   Pierce, NE 68767

Your membership will become active once payment is received.

Please provide the information below for the proper contact at your organization and return a copy of this letter with your payment. Feel free to call me with any questions at 402-329-6225. I thank you for your support of NITA.

Company Contact Information:
Contact Last Name.:  First Name:
Company Name .....:
Company Address. :
City . . . . . . . . . . . :  State ....:    ZIP.:
Phone # . . . . . . . .:   Fax # ...:
Cell/Mobil#: . . . . . :   Email . .:
URL . . . . . . . . . . .:

Sincerely,

Calvin L. Fluckey
President

(Please print and fax to Klint Arnold at 402-482-5700   and then send copy of page  with your payment.) Thank you!