2019

                                               New & Renewal

                                           Membership & Invoice

                                                                                         (Please Print)


                            Date: ____________________


           Company Name: ______________________________________________________________


                       Address: ______________________________________________________________ 


             City, State, Zip: ______________________________________________________________


                      Phone #: _______________________________________________________


                          Fax #: _______________________________________________________


                          Cell #: ______________________________________________________________


            E-mail Address:  _____________________________________________________________


                      Website: ______________________________________________________________


                 License #: _______________________________________________________________

     

      Company Contact: ______________________________________________________________        


  Contact Birth Month: _____________________


  Preference to receiving communications (please choose one): ______e-mail ______fax     



  2019 Contractor Membership


  Regular…$135.00   New or renewal of existing membership. (You only pay for web services once. )

                  

  Silver……$165.00   Includes a link from the NEFRSA website to your company website.


  Gold……. $270.00   Includes a custom designed member’s homepage.


  Platinum.. $300.00   Includes a link to your company web site & custom designed member’s homepage.

 

Note:  As a contractor member, once you’ve paid for a link or custom designed member’s homepage, you renew as  a

         regular member.



  2019 Associate Membership  

 

   Associate Membership ....$165.00  Includes a link from the NEFRSA website to your company website.

 

Please Make Check Out & Remit To:         NEFRSA 

                                                  P.O. Box 10124

                                                  Jacksonville, FL 32247-0124


  

Thank You For Your Continued Support and Participation






Filename: MemApp19