MembershipInstitution

MEMBERSHIP APPLICATION
NOTE: If you prefer to pay by check, please go back to our Member page to download printed form.

Name of Organization *

Primary Representative (1st name) *

Primary Representative (Last name) *

Suffix (if any)

Title: *

Email Address *

Phone: *

Mailing Address: *

City *

State *

Zip *

Representative #2 First Name

#2 Last Name

Email address #2

Phone #2

Mailing Address #2 (if different)

City (#2)

State (#2) *

Zip (#2) *

MEMBERSHIP DUES BY ORGANIZATION TYPE: *

Small volunteer-run charity ($150)

Small corporate ($300)

Corporate Associate ($500)

Corporate Professional ($1,000)

Sustaining Professional ($2,000)

NOTES:

For explanation on member categories, click here

QUESTIONS: 517-763-4413

Click "Continue" for payment options