I.T.M.A. Member Contact Information Update Form

ITMA MEMBERSHIP APPLICATION

Thank you for your interest in ITMA!

To apply for membership, please complete and submit the application form below.

I.T.M.A. memberships are valid per calendar year and must be renewed each year to be valid for that calendar year. Membership fees are not pro-rated. Please remember your payment goes towards ITMA Scholarships and Educational efforts.

- PLEASE SEND A COMPLETE FORM -

MEMBERSHIP IS CONTINGENT OF RECEIPT OF MEMBERSHIP DUES. ONLY MEMBERS IN GOOD STANDING WILL RECEIVE ALL MEMBER BENEFITS.

It is important that applicants complete all relevant information.

Fields captioned in RED
require data input in order
to submit this form.

Please do not use ALL CAPS
when entering your information.

Company Information

	Company Name
	Address
	City, State, Zip
	Web Address
	Description of Services (40 words max.)
	Membership Type Select Membership Type Referred by:

Individual Member
or
Primary Corporate Member

	Last Name, First Name
	Occupational Title
	Company
	Company Address
	City, State, Zip
	Phone (Work)
	Phone (Mobile)
	Pager
	Fax
	eMail
	Company Web Address
	I wish to become involved in the following ITMA functions:

Please Read Carefully

PAYMENT OF MEMBERSHIP DUES MUST BE MADE WITHIN 10 DAYS OF THIS REGISTRATION. ONLINE PAY IS AVAILABLE.

If you are an individual member or if you are the only
corporate member representing your company and
you have completed all of the information requested
above, go to the bottom of this page now and click
the "Submit" button (only once, please).

An ITMA corporate membership includes up to
five (5) memberships (total) for your company.

IMPORTANT - READ THIS...

If there are secondary corporate members that should be
included in ITMA corporate membership records, be sure to
complete all of the requested contact information for each
secondary member in the forms provided below.

Do not enter "same" or "see above" into secondary
corporate member information fields. Fields that do not contain
full contact information will not reflect information in the online
member directory.

Corporate Member #2

	Last Name, First Name
	Occupational Title
	Company
	Company Address
	City, State, Zip
	Phone (Work)
	Phone (Mobile)
	Pager
	Fax
	eMail
	Company Web Address
	I wish to become involved in the following ITMA functions:

Corporate Member #3

	Last Name, First Name
	Occupational Title
	Company
	Company Address
	City, State, Zip
	Phone (Work)
	Phone (Mobile)
	Pager
	Fax
	eMail
	Company Web Address
	I wish to become involved in the following ITMA functions:

Corporate Member #4

	Last Name, First Name
	Occupational Title
	Company
	Company Address
	City, State, Zip
	Phone (Work)
	Phone (Mobile)
	Pager
	Fax
	eMail
	Company Web Address
	I wish to become involved in the following ITMA functions:

Corporate Member #5

	Last Name, First Name
	Occupational Title
	Company
	Company Address
	City, State, Zip
	Phone (Work)
	Phone (Mobile)
	Pager
	Fax
	eMail
	Company Web Address
	I wish to become involved in the following ITMA functions:

Once you have completed all of the information that
applies to your membership above,
click the "Submit" button - only once, please.

Wait for the confirmation screen to appear;
this may take 60 seconds or more.

Then follow the stated instructions for paying membership dues.

Dues may be paid by MasterCard or VISA, or by check.