Regular Membership Form

This form must be completed annually by regular member states to ensure that contact information remains current for access to member resources and for accounting purposes.

A regular member is defined in the NCASG bylaws as the central human resource agency in the participating states. Participation as a regular member is limited to state governments of the United States.

I would like for my state to be a regular member of the NCASG for the annual term.

I understand that annual term dues are $450 for the July 1 – June 30 fiscal year.

I will ensure that my state participates in the NCASG annual survey activities.

I agree to support the NCASG mission.

State

Central Human Resources Agency Name

Primary Contact Name

First

Last

The primary contact must be within the state’s Central Human Resources Agency. This will be the voting member for the state.

Primary Contact Job Title

Select Survey Contact

Primary Contact Email

Primary Contact Phone

Select the applicable choice(s).

I will pay online via the NCASG website
I will mail a check payable to NCASG
I am requesting an invoice

Mailing address for checks: NCASG | c/o Ms. Terry Pickett | 9303 W. Iowa Avenue | Lakewood, CO 80232

Survey Contact Name

First

Last

Provide information for the individual that will serve as the state’s point of contact for all surveys if this info is different than the primary member.

Survey Contact Job Title

Survey Contact Email

Survey Contact Phone

Other State Contacts

Provide the name, job title, and email address for any other individuals that you would want to add to the NCASG Directory. These individuals will be invited to quarterly virtual meetings and receive general NCASG communications.

Billing Contact Name

First

Last

Provide information for the individual that will serve as the state’s billing contact for the membership payment.

Billing Contact Email

Comments

Provide any additional comments as needed.