NC Public Transportation Online Dues Membership/Renewal Form

READ THESE INSTRUCTIONS CAREFULLY BEFORE FILLING OUT THE FORM

Step 1: Submit Information Form and watch for email confirmation. Check your Spam/Junk Mail folder as well.

Information will be used for the Membership Directory.To avoid disruption of information services during the fiscal year, please notify NCPTA at info@nctransit.org of any email address changes.

Step 2: Payment - If paying online, use the "Pay Online" button on the online THANK YOU PAGE that will appear.

If paying with online invoice, select "Online Invoice Needed" if your System operating budget is over $4.5 Million.

If paying by mail, print confirmation e-mail you will receive and mail in with fees to the address in the email.

All fields are required unless noted.

Payment Method

Online Now (default method) Online Invoice needed (System Budget over $4.5M Only). By Mail

Member Information

Organization	Organization is required. If individual member, type your name.
Organization Web Address:	http:// Your Organization Web site is required. If you are an individual, please type: "Individual"
Membership Address:
Mailing Address	Enter your mailing address.
City	City is required.
State	State is required.
Zip code	5-Digit Zip code is required.5 digit code format.
Phone	Phone Number is required. Invalid format. Example: 919-555-1212 ex. 919-555-1212
Fax	ex. 919-555-1213
General Organization email	Invalid format.
Primary contact:
First Name	First Name is required.
Last Name	Last Name is required.
E-mail Address:	Primary contact e-mail is required. Invalid format.
Additional contact 1: (optional)
First Name
Last Name
E-mail Address:	Invalid format.
Additional contact 2: (optional)
First Name
Last Name
E-mail Address:	Invalid format.

Select Type of System Membership

System Member Description:
An Urban or Rural Transportation Provider.

Dues are based on Operating and Administrative Budget.

Operating Budget:
Select your DUES based on ranges below:

Dues increase $100 for every $250,000 budgeted above $4,500,000 ($4.5 M), if your budget is not listed above, select "Online Invoice needed" in the payment section at the top of this form. An online invoice will be emailed to you by NCPTA.

Enter Dues Amount: Check your DUES AMOUNT and enter here.
This amount is be shown on your email confirmation and registration records. Please make sure it matches your cart.

If paying by mail, please note "Dues Renewal" in the memo of check or money order.
Return completed application and check to:
NCPTA
PO Box 72048
Durham, NC 27722-2048

If this page doesn't give you a "thank you" message after you click submit, scroll UP on this page to see if you included answers to all required fields or view to error message by field with error. You will proceed to checkout on next screen.