NHMA

Company Name:

Date:

Street Address:

PO Box:

City:

State:

Zip:

Tel:

Fax:

Web Site:

Describe the primary business activity of your company as you would like it to appear in the association membership directory

No. of Employees in CT:

Years in business:

SIC

NAICS:

Please list names of those who should receive meeting notices:

First Name Last Name Title Tel: e-mail:

⁽¹⁾

How did you learn about the association?

Why does your company want to join the association?

What other trade or industry organizations does your company belong to?

Please recommend two manufacturing companies for membership: ⁽²⁾

Company:

Company:

Address:

Address:

Contact:

Contact:

Tel/e-mail:

Tel/e-mail:

A check for the full amount of the annual dues must accompany the application.

Annual Dues Schedule (based on no. of CT empl)

No. empl Dues No. empl Dues

1-4

$75

100-199

$300

5-19

$100

200-499

$400

20-49

$150

500+

$500

50-99

$250

Individual

Membership

$50