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Premier and Basic Program Applicant Information

To register for our Teacher's Program Membership click here

Contact Salutation

Contact First Name

Contact Last Name

Contact Title

Email Address

Repeat Email Address

Phone Number

Phone Ext.

Alternate Phone Number

Fax Number

Organization Name

Organization (Con't)

Federal Employer ID

Mailing Address

Mailing Address (Cont'd)

Mailing City

Mailing State

Due to excessive labor costs to process orders as well as high shipping costs, NAEIR is not taking applications from AK, HI, GU, PR, VI, APO, FPO. Thank you.

Mailing Zip Code

Shipping same as mailing:
(can not ship to P.O. Box)

Shipping Address

Shipping Address (Cont'd)

Shipping City

Shipping State

Due to excessive labor costs to process orders as well as high shipping costs, NAEIR is not taking applications from AK, HI, GU, PR, VI, APO, FPO. Thank you.

Shipping Zip Code

Date

Promotion Code

By checking this checkbox, I am confirming that I have read and understand NAEIR's Terms of Membership as outlined here.

Membership Type:

Basic ($59.00 annual fee)

Premier ($595.00 annual fee)

Premier 10-mo ($495.00 annual fee)

Premier Tiered ($250.00 annual fee)

Purchase Order / Member Referral (Optional)

Payment Options:

After your organization’s application is accepted and entered into NAEIR’s system, you will have the option to add multiple contacts for your organization.

NAEIR emails have the following domain names naeir.org, cmail19.com and cmail20.com. Please be sure that you allow emails with these domain names to come through and not be blocked as Spam. If you are using your school email address, please let someone in your IT department know that emails received with these domain names are not Spam. This way you will not miss out on any information that we send to our members.

If you are having problems submitting this application please click here for the PDF version of this application. Fax the application to (309)343-0583.