Group Membership Application

Group Membership

When people from the same workplace join MNSHA, membership dues are offered at a discounted rate.

Discount Options *

5-10 Members ($5 discount per member)

11+ Members ($10 discount per member

Please check which one applies:

Organization/Employer Name: *

Contact Name: *

Company Address: *

Apt, suite, etc.

Country

City

State

Zip code

Contact Phone: *

Contact Email: *

Member #1 - Full Name *

Email *

Member #2 - Full Name *

Email *

Member #3 - Full Name *

Email *

Member #4 - Full Name *

Email *

Member #5 - Full Name *

Email *

Member #6 - Full Name *

Email *

Member #7 - Full Name *

Email *

Member #8 - Full Name *

Email *

Member #9 - Full Name *

Email *

Member #10 - Full Name *

Email *

Member #11 - Full Name *

Email *

Member #12 - Full Name *

Email *

Member #13 - Full Name *

Email *

Member #14 - Full Name *

Email *

Member #15 - Full Name *

Email *

Member #15 - Full Name *

Email *

Member #16 - Full Name *

Email *

Member #17 - Full Name *

Email *

Member #18 - Full Name *

Email *

Member #19 - Full Name *

Email *

Member #20 - Full Name *

Email *

Printable Member Application (one per member)

http://mnsha.org/pdfs/membership-application.pdf

Upload Completed Member Applications for Each Member *

Accepted formats: pdf, png, jpeg, gif

Credit Card Type: *

Visa

MasterCard

Discover

American Express

Credit Card Number: *

Expiration Date: *

Group Membership Application

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