Agency
Address
City, State, Zip
Representative
E-Mail Address
Telephone
Fax Number

You may also complete and print this form, and mail it to:
          NCTHF
          P O Box 37191
          Raleigh, NC 27627-7191

BENEFITS OF BEING A COOPERATING AGENCY:
     -  Eligible for representation on the NCTHF Board of Directors;
     -  Agency name and logo displayed (at a minimum) at all NCTHF exhibits,
          on the NCTHF website; and in all NCTHF publications;
     - Entitled to reference association with NCTHF and to use its logo in
          promotional material (subject to NCTHF rules, guidelines and
          limitations); and
     - Preferential registration and seating at annual induction ceremony.