2017-2018 NRAA MEMBERSHIP APPLICATION Associate Members
2017-2018 NRAA MEMBERSHIP APPLICATION Associate Members Membership – July 1, 2017 to June 30, 2018 This application is in accordance with the NRAA Bylaws An Associate member is exclusively an INDIVIDUAL who is involved in the ESRD industry and supportive of the purposes of NRAA. These individuals are not directly employed by or otherwise involved in companies that are dialysis providers. These individuals are not eligible for membership as an Active member of NRAA. Associate Members do not have voting rights and are not eligible to sit on the NRAA Board of Directors.
ATTENTION: Before you complete the Associate member application, Have you checked if your organization is a current Active or Affiliate member? Please call 215-320-4655. If your organization is a current Active or Affiliate member, you are eligible to join as an Additional Contact for $50. If you are on the staff of an organization that fits the Active member or Affiliate member category, consider joining at those categories for the additional benefits. For both categories, additional contacts join at only $50 and receive communications and member discounts. Active members have voting privileges.
Member Information Name: Company: Address: City, State, Zip: Phone:
E-mail:
The individual makes application for Associate Membership in NRAA by submitting the above information for consideration. Name (print):
Signature:
Title:
Date: Supplying your email address gives the NRAA permission to communicate with you via email.
How did you learn about NRAA? Colleague/word of mouth Meeting (Please list: Magazine Ad/Editorial (Please list: Website: NRAA Other (Please list: Information from NRAA Office Other (Please list:
) ) ) )
Payment Information Membership Year – July 1, 2017 to June 30, 2018 Check or money order is enclosed (payable to NRAA)
Amount: $ 150.00
VISA MasterCard Amex Credit Card #
Exp. Date:
Name on Card: Signature: For federal tax purposes, NRAA membership dues may be deductible as a business expense but not as a charitable contribution. In addition, 35% of dues are not deductible due to state and federal lobbying activities as defined by the IRS.
Mail with Payment to:
National Renal Administrators Association 100 North 20th Street, Suite 400, Philadelphia, PA 19103 215-320-4655 [email protected]
Credit Card Applications may be FAXED to (215) 564-2175 Thank you for joining the NRAA! You will be contacted by our headquarters once you have been approved.
ATTENTION: Before you complete the Associate member application, Have you checked if your organization is a current Active or Affiliate member? Please call 215-320-4655. If your organization is a current Active or Affiliate member, you are eligible to join as an Additional Contact for $50. If you are on the staff of an organization that fits the Active member or Affiliate member category, consider joining at those categories for the additional benefits. For both categories, additional contacts join at only $50 and receive communications and member discounts. Active members have voting privileges.
Member Information Name: Company: Address: City, State, Zip: Phone:
E-mail:
The individual makes application for Associate Membership in NRAA by submitting the above information for consideration. Name (print):
Signature:
Title:
Date: Supplying your email address gives the NRAA permission to communicate with you via email.
How did you learn about NRAA? Colleague/word of mouth Meeting (Please list: Magazine Ad/Editorial (Please list: Website: NRAA Other (Please list: Information from NRAA Office Other (Please list:
) ) ) )
Payment Information Membership Year – July 1, 2017 to June 30, 2018 Check or money order is enclosed (payable to NRAA)
Amount: $ 150.00
VISA MasterCard Amex Credit Card #
Exp. Date:
Name on Card: Signature: For federal tax purposes, NRAA membership dues may be deductible as a business expense but not as a charitable contribution. In addition, 35% of dues are not deductible due to state and federal lobbying activities as defined by the IRS.
Mail with Payment to:
National Renal Administrators Association 100 North 20th Street, Suite 400, Philadelphia, PA 19103 215-320-4655 [email protected]
Credit Card Applications may be FAXED to (215) 564-2175 Thank you for joining the NRAA! You will be contacted by our headquarters once you have been approved.
