Member Listing Request

If you would like a copy of our NSATA list for OFFICIAL NSATA COMMITTEE PURPOSES, please fill out the information form below. The Executive Board will review your request and release information as appropriate. Please note this is a controlled list containing important member information so please request only what you need for OFFICIAL NSATA COMMITTEE duties.

This information is confidential and will not/should never be released to any third parties outside of the NSATA. In doing such without explicit consent from included parties, violates federal privacy acts and subject to associated punishments. Records for auditing purposes will be kept indefinitely.

Membership List Request

Requester Name (First and Last) *

Requesting Committee *

Requester Phone Number *

Requester Email Address *

Date Requested *

Date Information Needed by *

If no specific date, please estimate. Note it may take up to 30 days to process the request.

Please write a brief justification of why you are requesting the following information and to what capacity it will be used. *

This helps the board make a decision to release this information so be detailed but brief.

Select Information You Would Like to Request *

Member Number

Member Type

Date Joined NATA

Membership Paid Through

Name - Prefix

Name - First

Name - Middle

Name - Last

Name - Suffix

Name - Full

Professional Designations

Nickname

Company

Address

City

State

Zip Code

E-mail Address

Work Phone Number

Home Phone Number

Please select only information pertanant to the scope and duties of your committee

Member Types *

Certified Professional

Licensed Professional

Associate

Certified Student

Student

Certified Retired

Retired

Please select the member types you would like included

Additional Info/Requests

By submitting this form, I agree that the requested information is pertinant to performing my duties as a part of an approved NSATA committee. If approved, I agree to handle the provided information descreetly, properly store and destroy information after use. I agree I will not share any of the membership information to outside parties. *

I agree

Signature

Clear