MLMIA - Support Membership Application

Company Name:

President / CEO:

Address:

City:

State:

Zip:

Phone:

Fax:

Fax On Demand:

Email:

Web Site:

Mailing Address (If different from above):

Your company is entitled to two officer/staff representatives - Only these representatives may vote or hold office.

Primay Representative:

Title:

Additional Representative:

Title:

SUPPORT MEMBERSHIP DUES

Under $250,000.00 in yearly industry billing

$500.00

Between $250,000.00 and $500,000.00 in yearly industry billing

$750.00

Over $500,000.00 in yearly industry billing

$1,000.00

Method of payment:

Check - payable to MLMIA

Visa

AmEx

MasterCard

Credit Card Number:

Expiration Date:

Print Name On Credit Card:

Signature:

We hereby apply for membership in the Multi-Level Marketing International Association (MLMIA). We understand that to be accepted for active membership we agree that we (a) will operate in a professional manner with high moral standards, (b) will subscribe to and uphold the principles and ethics prescribed by the Association, and (c) will continually strive to meet all requirements and standards established by the Association. We understand that to remain a member in good standing our membership must be renewed anually.

Signature:

Date:

OFFICE USE:

EX

QB

MS

DJ

ECD

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