Membership

>No. of Voting Members-$115.00	*
Total for Voting Members
>No. of Associate Members - $75.00 (Must reside Outside the State of Michigan)	*
Total for Associate Members
>No. of Affiliate Members - $30.00	*
If Voting Member Level, please list Affiliate Member name(s) and contact information (if different than Voting Member):
Total for Affiliate Members
>No. of Student Members	*
Total for Student Members
First Name	*
Last Name	*
Company	*
Address	*
Address 2
City	*
State/Providence	*
Zip Code	*
Phone	*
Fax	*
Email Address	*
Website Address
Total Membership Dues
Credit Card Number	*
Expiration Date Month	*
Expiration Date Year	*
CCV	*
Comments
Security Code	*