NHLA Membership Application Form

Membership

Membership Application Form

Individual Name
Firm Name
Street
City
State
Zip
Cell Phone
Business Phone
Fax
E-mail Address
Website
Number of employees in your firm
Would you be willing to serve on a NHLA committee?
	Yes No
How did you hear about NHLA?
Can you recommend someone for membership?
Name
Street
City
State
Zip
Phone

Annual Dues: $130.00 (September 1 - August 31)
Prorated dues schedule for new Regular members. Renewals are due Sept. 1 each year.
If joining in the date period below, you owe the dues noted to the right of that:
June 1 - Nov. 30	$130.00
Dec. 1 - Feb. 28	$100.00
March 1 - May 31	$65.00
Student Members, at any time	$25.00

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