Free Newsletter :
NSCIA Online Membership Form
Font Size : A   A   A Bookmark and Share

ADVERTISEMENT:
Official Seal - NSCIA CT Chapter
>> Home >> Membership >> Online Membership Form

In order to fullfill your request, we ask that you please fill out and submit the information in the form below so that we may begin processing your membership information. Membership is free of charge, however donations to the chapter are always welcome. Please click here for more information. You may click here to review CT Chapter Membership benefits and information.

** As always, you have our personal guarantee that this information will be kept private & confindential and will only be used for the purposes of our membership benefits and services! If you do not wish to submit this information over the Internet, you may call the CT Chapter directly at (203) 284-1045 and request that a Membership form be sent to you via regular mail.**

 * = Required Info!
First Name: *
Last Name:*
Email: *
  (Ex: "MyName@MyISP.com")
Is this a NEW membership? Choose "No" if you wish to RENEW an existing or lapsed membership?
Yes  
No  
Company:
Address:
City:
State:  (Ex: CT, NY, RI)
Zip:
Country:
Phone:
Disability: (note: this information is not required)
Para
Quad
Able-Bodied
Other (please specify) 
Additional Comments:

Please click SUBMIT button ONLY ONCE!! It will take a few moments for us to process your membership. Please be patient until the Confirmation Screen Appears. Thank you!


Top of Page
Save the Date
  • Reeve's foundation Band Fundraiser February 28 2012
    5:00 pm - close
    more info...



ConnCord Online
The latest ConnCord Newsletter is ONLINE!

Download NSCIA CT ConnCord Newsletter
Download
your copy...
Copyright © 2012 NSCIA CT Chapter. All rights reserved.