Membership Information

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Prefix:
First Name: *
Last Name: *
Phone Number: *
Cell Number:
E-mail Address: *
Street Address: *
Address Line 2:
City: *
State: *
Postal Code: *
Membership Desired *ETEI ($20)
ETEI Student ($5)
ETEI Retired ($5)
Please type your name and school/business:
ETEI District
* RequiredEmail form by myContactForm.com
Please fill out the information below. Upon completion you had two choices for submitting.
1) Submit the form by clicking on the "Submit" button.  This will email your form to info@etei.net. You will then need to make a payment using the appropriate PayPal link below.







2) Print out the form by clicking on the "Print" button below.  Mail the form with a check to:
Brian Bettag
1020 North 21st St.
Lafayette, IN 47904