(Please print application for mailing.) ( ) New ( ) Renewal
APPLICANT INFORMATION: ( )Mrs. ( ) Ms. ( )Mr. ( ) Other ________________________
NAME: _____________________________________________________________________
TITLE: ______________________________________________________________________
ORGANIZATION(Line One): _____________________________________________________
(Line Two): __________________________________________________________________
STREET ADDRESS: __________________________________________ # ______________
CITY_______________________________________STATE ______ ZIP CODE ___________
PHONE ( ) _______________________ FAX ( ) ______________________
CELL/PAGER ( )__________________________________________________________
E-MAIL ADDRESS: ___________________________________________________________
NAME OF "MATCHING" PLANNER______________________________________________
(supplier/contract organization applicant may be required to have a planner "match")
(Check One) _______ PLANNER/MANAGER ($100.00)
_______ SUPPLIER/CONTRACT ORG. ($265.00)
_______ EDUCATOR/STUDENT ($65.00)
Please submit completed application and payment to:
NAMMM MEMBERSHIP
P.O. BOX A-3247
CHICAGO, IL 60690-3247
Check ( ) Money Order( ), *AMEX( ), ____________________________ Exp ____/____
(mo/yr)
_________________________________________________ ______________________
Signature Date
*Until further notice the AMEX card will not be accepted.
