MEEC Membership Application

New Member Application

Name of Institution:

Website/URL

Address

Type of Institution

Education Mission:

Type of Accreditation:

Primary Contact

Primary Contact

Name (First and Last):

Name (First and Last):

Title

Title

Phone

Email

Procurement Contact (optional)

Procurement Contact (optional)

Name (First and Last):

Name (First and Last):

Title

Title

Phone

Email

CIO Contact (optional)

CIO Contact (optional)

Name (First and Last):

Name (First and Last):

Title

Title

Phone

Email

CEO/President Contact (optional)

CEO/President Contact (optional)

Name (First and Last):

Name (First and Last):

Title

Title

Phone

Email

What type of procurement interests do you have

Hardware

Software

Services

Full Time Students:

Full Time Employees

Part Time Faculty:

Part Time Employees

Applicant Name

Application Date

If you are human, leave this field blank.

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