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Name of Organization / Business:
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Name of Contact:
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Type of Organization or Business: (educational,
consulting, petroleum, etc.)
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Mailing Address:
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City:
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State, Zip:
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Email:
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Phone:
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Fax:
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Web Site Address:
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What / Who Prompted You to Join?
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Membership Dues:
(Please Refer to Chart Below)
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Voluntary Contribution:
($50 recommended)
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Total Dues:
(Sum of Dues and Contribution)
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| MEMBERSHIP DUES BREAKDOWN |
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Number of Professionals
in Organization or Business
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Fewer than 50
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$100
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51-100
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$150
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101-150
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$275
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151-200
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$350
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201-250
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$500
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More than 250
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$600
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