National Consumer Telemarketing Group       www.geocities.com/nctg_online             Changing the Tone of Telemarketing

Consumer Membership Form

By returning this form and joining NCTG, you agree to the terms and conditions outlined on the NCTG Membership Agreement.  You must read and agree to these terms before your membership can be accepted.  Please initial here to indicate that you have read, signed and agreed to the Membership Agreement terms ________.

To join NCTG, print this form and return it along with your signed Membership Agreement and Membership fee of $20.00 (check* or money order) to

NCTG

518 Osborne Ave

Morrisville, PA 19067              *  See membership agreement

Required Information*

Member Last Name:   ______________________________ 

Member First Name:   ______________________________

Street:                      ______________________________

City:                         ______________________________

State:                       _________________

Zip:                          _________________

Primary Phone #:      _________________

Other Household Members Above 18:

Name                                   Age  Sex           

_____________________   __      __

_____________________   __      __

_____________________   __      __

_____________________   __      __

_____________________   __      __

_____________________   __      __

*  Please note that your membership will not be processed without all required information

Optional Information

Alternative Phone #:  ______________________________

Call alternate phone #:    Yes      No

Email Address:        ______________________________

Age:                        ______________________________

Sex:                             Male     Female

Race:   Asian     Black     Hispanic    White     Other

Household

Salary Range:   $0                            $40,001 - $50,000                         

                         $1 - $10,000            $50,001 - $60,000                         

                         $10,001 - $20,000   $60,001 - $90,000                         

                         $20,001 - $30,000   $90,001 - $150,000                     

                         $30,001 - $40,000   $150,001+                   

Hobbies:                ______________________________  

                             ______________________________  

Profession:             ______________________________

REFERED BY:       ______________________________

If a family member or friend referred you to NCTG, please include their name in this section in order for them to receive appropriate credit. 

______________________________________      _____________________

          Member Signature                                        Date

See our website for more information on how the NCTG program works at www.geocities.com/nctg_online