NAMA On-Line Membership Form

Please enter the requested information about yourself. Provide additional information in the comment box. Choose the "Continue" button located at the end of this form to go to the next screen to select your chapter and payment type. You can pay your dues with a credit card (Master Card, Visa, American Express), by check or request that NAMA send you an invoice. Please note that the NAMA payment site is secure for credit card transactions.

If you are referring someone for membership, please indicate whether you want information sent to this person and if you want this person billed by checking the appropriate boxes.

Contact Information:
(Required fields are designated by an "*".)

* Name:

Title:

* Company:

* Address:

Address Cont:

* City:

* State:

* Zip Code:

* Phone Number:

Cell Phone Number:

Fax Number:

* E-mail:

Homepage:

Referred By:

Student Chapter:

Comments:

Job Profile Information:

Please complete the following questions by clicking on the appropriate box.
1. Professional Development Areas: Check the area that best describes your primary job responsibilities or experience.
Marketing Communications Product/Species Management	Public Relations Sales
2. Which title best describes your position? (Please check one below.)
Entry Level Junior Management Middle Management	Senior Management CEO/Owner Retired
3. What sector of agri-marketing are you in? (Please choose only one.)
Manufacturer/Ag Input Supplier (If Yes, Check One Below) Animal Health Ag Production Building/Construction Co-Operative/Distributor Consulting Field Equipment Genetics Livestock Equipment Feed Fertilizer Finance/Insurance Petroleum Processing Seed Other (Please Indicate): Agency (If Yes, Check One Below) Advertising Direct Marketing Market Research Product Publicity Public Relations Other (Please Indicate):	Media (If Yes, Check One Below) Broadcast Computer/Satellite Outdoor Premiums/Incentives Print Trade Show/Special Event Mixed Other (Please Indicate): Other (If Yes, Check One Below) Association Government Personnel Search/Placement University/Education Other (Please Indicate):
4. What area of agriculture are you involved in?
Crops Livestock/Poultry Dairy	General Agriculture Fruits/Vegetables/Nuts

AgriMarketing Magazine:
Please check if you would like to receive a free subscription to AgriMarketing Magazine.

Information Submission:
Please provide your name and e-mail address if you are submitting this form for someone else.

Submitter's Name:

Submitter's E-mail:

Please send more information about NAMA to the person being recommended for membership.