MDII Out Of State Enrollment - National Digital Equity Center

Payment for Out-Of-State MDII Annual Subscription

You have enrolled in the Maine Digital Inclusion Initiative as a participant from a state other than Maine. Please complete the payment form below. To immediately access free online classes and tutoring, please pay online with a credit or debit card.

Name of Person Enrolled*
First Last
Company or Organization, if applicable
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Address If Different From Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
MDII Out of State Subscription
Price: $50.00
Will you pay for your subscription yourself or will a referring organization pay for your subscription?
- Self Pay
- Referring Organization
If payment is from a referring organization, please note that your access to free classes will begin when payment is received from that organization.
If self pay, will you be paying by check or by credit/debit card or PayPal online?
- Pay by check
- Pay by credit/debit card or PayPal (see below).
If paying by check, please address check to: National Digital Equity Center PO Box 397 Machias, ME 04654 We will notify you when your payment is received and you can register for classes for free.
Payment Method

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name