MARCUMS 2019-2020 Membership Invoice

MARCUMS 2019-2020 Membership Information Invoice

This form is for payment by invoice only. Please fill out the requested information to complete your MARCUMS registration. This form should be filled out by all the individuals who will be members. Membership is valid from July 1, 2019 - June 30, 2020.

Membership
Membership Type

Individual Membership $40 (1) Institutional Membership $70 (up to 4 members)
Renewal Type

Renewal New Member from a Renewing Institution New Member from a New Institution
How would you prefer to receive your MARCUMS Newsletter? *

Digital - PDF through Email Hard Copy - USPS First Class

Contact Information
Name *

First Name Last Name
College/University Name *
Department *
Job Title *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Email *
example@example.com
Work Phone Number *

Area Code Phone Number
Fax Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Alternate Email
example@example.com

Reference Information
How did you hear about MARCUMS? *

I am a long standing MARCUMS Member. MARCUMS Member (Sponsor) NACUMS Member
Sponsor Name

First Name Last Name
Sponsor College/University

Payment
Invoice Information

Individual Membership (1) $ 40.00

Institutional Membership (up to 4) $ 70.00
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