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
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