• INTEGRITY • COMMON SENSE • SOUND SCIENCE • FISCAL RESPONSIBILITY •

Become a Member:

Name*
First Last
Position/Title*
Company Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Company Website
Secondary Contact Name*
First Last
Secondary Contact Email*
Please Summarize the services your company offers:*
Please check the following committees you are interested in serving:*
- Science & Governmental Affairs Committee
- Scholarship Committee
- Membership Development Committee
- Communications Committee
- Events Committee
Payment Options
(Payment must be made in full prior to application acceptance) ANNUAL DUES: $295.00
Credit Card Type
Please Choose One
Card Number
Exp. Date
CVV
3 Digit Number on back of card
Check
please mail check payment AND completed, printed application to Nancy Kapral at the address
Annual Dues*
Price: $295.00 Quantity:
By submitting this application, I consent that the EMA may contact me at the specified address, telephone numbers, fax numbers, email address or other means of communication available. This consent applies to changes in contact information that may be provided by me to the Association(s) in the future. This consent recognizes that certain state and federal laws may place limits on communications that I am waiving to receive all communications as part of my membership. All pending membership applications are posted to www.emaweb.org as prescribed in the Association bylaws. Membership applications are subject to EMA Board of Directors approval.*
- Accept Communications Agreement
Signature*
Date*