Credit Card Payment Submission

(complete form below before submitting payment)

Download - Member Registration PDF

Organization Information

Primary Contact Person / Administrator

Agency/Organization

Name

Title

Address

Address 2

City, State, and Zip Code

Phone Number

Fax Number

Please add staff members who would like access to the members’ online forum at the bottom of this form.

TEDPA State Membership Dues

July 1, 2026 to June 30, 2027

$350 per state applying for membership

Payment Options

Paying by credit card - Use the payment link above to pay by credit card (3% transaction fee will apply).

Paying by check - invoice will be emailed

Treasurer must complete online purchase order process. Please provide that information via email.

Please make check payable to:

TEDPA

301 W Preston Street

Suite 1008A

Baltimore, MD 21201

If possible, please mail check to:

Laura Grassia

116 Manhasset Trail

Medford Lakes, NJ 08055

Contact Information:

Voice: 215-204-5966

Toll-Free: 800-204-7428

Text: 610-608-2826

Email: Laura.Grassia@temple.edu

Additional Staff Members

Staff Member 1

Name

Title

Agency/Organization

Address

Address 2

City, State, and Zip Code

Phone Number

Fax Number

Staff Member 2

Name

Title

Agency/Organization

Address

Address 2

City, State, and Zip Code

Phone Number

Fax Number

Staff Member 3

Name

Title

Agency/Organization

Address

Address 2

City, State, and Zip Code

Phone Number

Fax Number

Staff Member 4

Name

Title

Agency/Organization

Address

Address 2

City, State, and Zip Code

Phone Number

Fax Number

Please Note

Members shall be limited to those individuals, contractors to the administration, and their staff who have, or expect to have, direct responsibility for the administration or oversight of Specialized Telecommunications Equipment Distribution Programs. Members will have voting privileges and will also have access to the members-only section of the TEDPA website. During TEDPA business meetings, each state shall have one vote per state.

Vendors are not eligible unless they are the legislatively appointed administrator.

Credit Card Payment Submission

Download - Member Registration PDF

Organization Information

Primary Contact Person / Administrator

TEDPA State Membership Dues

Additional Staff Members

Staff Member 1

Staff Member 2

Staff Member 3

Staff Member 4

Download - TEDPA W-9 2026

TEDPA Member Registration