Membership and Dues


MEMBERSHIP APPLICATION AND RENEWAL FORM Please check ALL that apply: Annual Dues: I would like to pay my annual dues. Members: I need to update my member information. Membership: I would like to join. Required fields are marked with asterisks Referred By: Date:
Name: *
Position Title:
Institution:
Address:

City:
State:
Zip:

Telephone (Business):
FAX:
E-Mail: *
Telephone Home:	(If retired, unemployed or prefer contact at this number.)
Principal EM Interest: Biological Sciences Physical Sciences
Membership in Affiliated Societies: MSA MAS
Membership Type Professional - $20 Corporate - $50 Student - $5 Retired - Waived
IMPORTANT - Once you click submit your information will be sent electronically to the MSNO treasurer (contact information below) and you will be forwarded to another url so that you may print out the information and electronically submit your payment. If you prefer to pay by mail cancel this form by closing this browser window and fill out the forms available online and mail to: Kimberly Sloan Stakleff MSNO, Treasurer 2552 Brice Road Akron, OH 44313 kstakleff@agmc.org