Membership/Renewal Application

 
Name
 (First, M. Last)
Address
City
   State   Zipcode

Home Phone
Email 
Fax Number
Work Phone 
AHDI Number
CMT Number
Employer
Date of Birth (Month/Day)
Referring member
(if applicable)

Membership is for one calendar year beginning January 1 and ending December 31 of that year. Membership includes a one-year subscription to the quarterly newsletter of the Greater Jacksonville Chapter of AHDI. Membership also includes one chapter pin. Dues and benefits are nonrefundable and nontransferable.

GJC-AHDI dues and donations are not deductible as charitable contributions for federal income tax purposes, but they may be deductible as ordinary and necessary business expenses.
AHDI/GJC occasionally rents its membership list to carefully screened vendors who provide services and products of interest to MTs. If you prefer not to receive such mailings in the future, please initial the line below, and your name will be withheld from list rental.

    Please withhold my name.


Membership

I prefer to mail my payment.
(Check this box if you DO NOT wish to use online payment. )



 
Copyright © 2008 Greater Jacksonville Chapter of AHDI.