Annual Regular Membership Registration

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 $400 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.

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State *

Central Human Resources Agency Name *

Primary Contact Name *

First

Last

The primary contact must be within the state’s Central Human Resources Agency.

Primary Contact Job Title *

Primary Contact Email *

Primary Contact Phone *

Secondary Contact

First

Last

State Agency Name

Secondary Contact Job Title

Agency Secondary Secondary

Secondary Contact Email

Secondary Contact Phone

Submit