Teaming for Technology Membership Enrollment Form * Required Fields   Organization Contact Information   Organization Name* Address1* Address2 City* State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip code* Telephone ( #s only )* Fax Number ( #s only ) Email Address Website Address Typical Office Hours Tax ID#     Primary Contact Information     Title Mr. Mrs. Ms. First Name* Last Name Job Title Address1 Address2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip code Telephone ( #s only ) Fax ( #s only ) Email Address Best Time To Reach     Additional Organization Information     Mission Statement Number Of Staff Full Time    Part Time Programs and Services Offered Geographical Areas Served What is your annual operating budget? What is your first priority for using technology to improve your program/services?