New Membership

	( * = required field )
Member Company
	Company: *
Mailing Address
	Street Address 1: *
	Address 2:
	City: *
	State/Province: *	-- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico Nevada New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington D.C. -- Canada -- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
	Postal Code: *
	Country (if other than USA):
	Please do not give a home address
Primary Participant
	First Name: *
	Middle Initial:
	Last Name: *
	Credentials:
	Job Title: *
	E-mail Address: *
	Telephone: *
	Cell Number:
	Fax Number: *
Mailing Address
	Address same as company (above)
	Street Address 1: *
	Address 2:
	City: *
	State/Province: *	-- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico Nevada New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington D.C. -- Canada -- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
	Postal Code: *
	Country (if other than USA):
Secondary Participant
	First Name:
	Middle Initial:
	Last Name:
	Credentials:
	Job Title:
	E-mail Address:
	Telephone:
	Cell Number:
	Fax Number:
Mailing Address
	Address same as company (above)
	Street Address 1:
	Address 2:
	City:
	State/Province:	-- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico Nevada New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington D.C. -- Canada -- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
	Postal Code:
	Country (if other than USA):
Secondary Participant
	First Name:
	Middle Initial:
	Last Name:
	Credentials:
	Job Title:
	E-mail Address:
	Telephone:
	Cell Number:
	Fax Number:
Mailing Address
	Address same as company (above)
	Street Address 1:
	Address 2:
	City:
	State/Province:	-- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico Nevada New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington D.C. -- Canada -- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
	Postal Code:
	Country (if other than USA):
Payment
	Amount Due:	$
	Payment Method:	-- Select -- Credit Card Check
	EXPLANATION OF PARTICIPANTS’ PRIVILEGES: Each MAG company membership includes participant rights/access for one Primary Member and up to two Associate Members. The Primary Member receives all MAG Member communiqués and a fully paid registration fee to attend the MAG’s annual conference. All participants receive login rights to the MAG web site’s Members-only features and are permitted to serve on the MAG’s organizational Committees.