Please enter the requested information about yourself. Provide additional information in the comment box. Choosethe "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:

Please provide the following contact information.  Also, if your job responsibility has changed over the past year, please provide an update of your profile information by answering questions 1 through 4.  Choose the "Continue" button located at the end of this form to go to the next screen to select your chapter and method of payment. 

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.
(required) Name:
If your contact information has NOT changed, please check the box on the left and then proceed to questions 1 through 4 below. Then choose the "Continue" button located at the end of this form to go to the next screen to select your chapter and method of payment.
Title:
Company:
Address:
Address Cont:
City:
State:
Zip Code:
Phone Number:
Cell Phone Number:
Fax Number:
E-mail:
Homepage:
Student Chapter:
Comments:
Job Profile:
If your job responsibilities have changed over the last year, please complete the following questions by clicking on the appropriate box.
1. Which title best describes your position? (Please check one below.)
Entry Level
Junior Management
Middle Management
 Senior Management
CEO/Owner
Retired
2. 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):

3. What area of agriculture are you involved in?
Crops
Livestock/Poultry
Dairy 		General Agriculture
Fruits/Vegetables/Nuts