Affiliate Membership Renewal
Dues pay for membership through December 31, 2019. To apply for membership please complete all questions. If you have any questions, please email operations@macuma.org.
Company Name
*
Primary Billing Contact
*
First Name
Last Name
Primary Billing Contact Email
*
Primary Contact Phone Number
*
-
Area Code
Phone Number
Directory Information
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Phone Number
*
-
Area Code
Phone Number
Website
*
Fax
Please list all staff members you wish to include in the directory. Please include Name, title, email, and contact phone number.
Please select your membership tier based upon your staff size.
*
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Small Staff Affiliate (1-2 staff members)
$
349.00
Affliate Dues
$
599.00
Credit Card (Please list the name that appears on the card.)
Submit application
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