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

To have your institution included in this year's promotional material and/or included on our web site, please send your dues to the address below. If you have any immediate questions, please complete the comment portion of this form or call Robert Dinello at 518-381-6295.
Please indicate your intent on this form and mail to:
NATYC, Inc. Robert E. Dinello, Exec. Dir. P.O. Box 2126 Scotia, NY 12302 Or Fax to: 518-370-4547
2003-2004 BILLING
College or Institution ____________________________________________________
Contact ___________________________________________________________________

Your Institution's Dues (based on FTE)
$100__ (under 1100) $200__ (1100-2099) $300__ (2100-6099) $400__ (6100+)

Dues will be processed by this date ______________
Billing Phone Number ________________ Billing Fax Number ________________

Signature ________________________________________ Date ________________

Make checks payable to NATYC, Inc.

For your NATYC, INC. web site listing:
E-Mail Address ____________________________________________________________
Web Address (URL) _________________________________________________________
Name of Web master ___________________________ Phone Number ______________

If you completed this section last year, please update it for this year. Thank you.

Contact Robert E. Dinello at the following:
Phone: 518-381-6295 Fax: 518-370-4547 E-Mail:
Questions: _______________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
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