Northeastern Association of Two-Year Colleges, Inc.
               Four-Year College Associate Membership Form
                    (Federal Id.# 23-7345879)

Please complete the following information below for an Associate Membership.
____ Associate Membership $200

Make check payable to NATYC, Inc., and mail to:
NATYC, Inc. Robert E. Dinello, Exec. Dir. P.O. Box 2126 Scotia, NY 12302
Please Print
Institution _______________________________________________________________
Contact ___________________________________________________________________
Fax Number ___________________ E-Mail Address ____________________________
Dept. ________________________ Title _____________________________________
Daytime Phone Number ________________ Evening Phone Number ________________
Signature ________________________________________ Date ________________
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