Application for Associate Membership
(Please note: Associate Memberships are only available to
members who already hold an Int'l. membership with MPI)
Name___________________________________________________________________
Title____________________________________________________________________
Company________________________________________________________________
Address_________________________________________________________________
City________________________________ State____________ Zip________________
Phone Number_________________________ Fax Number_______________________
E-Mail Address ___________________________________________________________
_____ Planner _____ Supplier
In what chapter do you hold your MPI membership?____________________________
How many years as member of MPI?________ Member No._____________________
Description of your company:______________________________________________
_______________________________________________________________________
_______________________________________________________________________
Signature_______________________________________________________________
_____ Check for $75.00 Enclosed
_____ Please charge to American Express, Mastercard or VISA
Card No.________________________________________________ Exp. ________________
Authorized Signature____________________________________________________
Phone (602) 277-1494 • fax (602) 240-5553