The Ergonomics Center Of North Carolina - Center Memberships


		Contact Us \| Sitemap \| Home

APPLICATION FORM

* required fields

Company Name*

Mailing Address*

City*

Country*

State*

Zip*

Phone Number*

Fax Number

Contact Name*

Contact Title*

Contact Email*

Type of Business*

Referred By

Select Membership Level*

	Sustaining $250 Includes Unlimited Center Membership Web Portal access, 10% discount on Center workshops, and 10% discount on consulting services. Indicate name of person to receive membership materials: Name Title
	Professional $500 Includes single Center Membership Web Portal access, single edgar acess (access contingent upon system availability), 10% discount on consulting services, and 50% discount on Center workshops for one attendee. Indicate name of person to receive membership materials: Name Title

	Site Level Consulting $3000 Includes unlimited Center Membership Web Portal access, edgar access for multiple individuals at member site (access contingent upon system availability), 20% discount on consulting services, 16 hours of consulting credit, and Center workshops discounted 50% (unlimited attendees). Indicate name of person to receive membership materials: Name Title
	Site Level Training $3000 Includes unlimited Center Membership Web Portal access, edgar access for multiple individuals at member site (access contingent upon system availability), 10% discount on consulting services, three free Center workshop attendees (good for one week of training per attendee, and additional Center workshops discounted 50% (unlimited attendees). Indicate names of persons to attend workshops (Persons who attend all workshops must be the persons listed below): Name Title Name Title Name Title
	Corporate $5000 Includes unlimited Center Membership Web Portal access, edgar access for multiple individuals corporate-wide (access contingent upon system availability), 20% discount on consulting services corporate-wide, 16 hours of consulting credit, one free Center workshop attendee (good for one week of Center training in Raleigh), and additional Center workshops discounted 33% corporate-wide. Indicate name of person to attend workshop (Person who attends all workshops must be the persons listed below): Name Title
	NC Government Partnership (No Cost) Includes unlimited Center Membership Web Portal access, 40% discount on all Center workshops, and 40% discount on consulting services.

Research Partnership
Includes unlimited Center Membership Web Portal access and discounts on professional administrative fees (dependent on the scope of the project.

Payment Options

Payment Type*		If paying by check, please mail to: The Ergonomics Center of North Carolina, 3701 Neil Street, Raleigh, NC 27607 If paying by credit card, someone will contact you to obtain card information.
Company PO#
		Membership fees are non-refundable and non-transferable.

Please don't mention my company in Center marketing materials.