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Associate Company Member Application


The information you provide below will be used to create your NCTC member profile and will be displayed in the NCTC Member Directory, a searchable database of our membership, available on the NCTC website. Fields marked with an * are required, but all other fields are optional. We encourage you to provide as much information as possible because the NCTC Member Directory provides the detail necessary to "describe" the technology community in the NewVa region. If you do not provide a response for an optional field, that field will not be displayed as part of your profile.
Company Name:*
(This field is Public. Fields marked as "Public" will be displayed to the user viewing your company profile.)
Website:
(This field is Public. Please use http://www.yourURL.com format.)
Company Description:
(This field is Public. Limit 500 characters. If your organization is not headquartered in the NewVa region or has multiple facilities, please include detail about the local operation. For example: manufacturing, sales office, R&D, etc.)

Technical Capabilities
We often get calls at the NCTC office from members looking for a local partner with specific technical expertise or capabilities. Our goal with this section is to build a database that includes the collective technical capabilities of the NCTC membership. Unlike the “Company Description” section which tells us what you do, this section should focus on what you know, your technical skillsets & capabilities, areas of expertise, specialized knowledge, specific technologies, etc. This “block” is here to help you augment your member profile in a way that will help other members (and non-members) find you. We encourage you to make it as comprehensive as possible without the unnecessary. You can always come back to update this field later.
Technical Capabilities Description:
(This field is Public. Limit 500 characters.)
In which of the following industry/technology sectors does your company operate? (This field is Public. Mark the sectors that your company is directly engaged in, not the sectors/services of your clients. Select all that apply.)
Company Address:*
(This field is public and visitors can display the location on a map. If your organization is not headquartered in the region, please use the address of your local operation, if any.)
Mailing Address
(Optional. This field is Public)
Primary Contact:*
(This field is Public)
Title:*
(This field is Private. Fields marked "Private" are visible only to you and to the NCTC staff.)
Email:*
(This field is Private.)
Phone:*
(This field is Private)
Alternate Contact:
(This field is Public. Would you like to designate someone else within your organization as a point of contact?)
Alternate Phone:
(This field is Private)
Alternate Email:
(This field is Private)
# of employees:*
(This field is Private. How many people does your company employ within the NewVa region?)
Do you wish to be contacted about the following? (This field is Private)
Commitee Interest? (This field is Private. Is there someone in your organization that might want to participate in any of these committees/forums?)
From time to time, we may update our Member Profile form to collect additional detail about our members. When we do, you will be notified so you can update your company profile. Membership applications and updates will be reviewed and approved by NCTC staff before changes will be viewable on the NCTC website.
* indicates required fields.

Payment Information
Payment information must be included for your application to be completely processed. You can pay for your membership by printing your membership application and sending a check or online with a credit card. Click the button below to submit your application and proceed to payment options.