Please Type or Print ___Renewal or ___New Member
Name (Dr|Mr|Ms) ______________________________________________________
Organization _________________________________________________________
Address ______________________________________________________________
Address ______________________________________________________________
City ____________________________ State ______ Postal Code ___________
Email ___________________________ Phone _____________ FAX ____________
Student? ___ University ____________________ ID Number ____________
Check if you prefer to NOT be included on the members mailing list: __
Indicate your payment and membership
type, and submit it as follows:
Make checks payable to CNRI. The check
must be U.S. dollars drawn on a U.S. bank.
Send membership registration with payment to:
Corporation for National Research Initiatives
ATTN: Accounting Department - PSA
1895 Preston White Drive, Suite 100
Reston, VA 20191-5434
You can FAX credit-card based memberships: (703) 620-0913.
Please do not send credit information via email - we do
not have provisions for secure transmission.
Also, no person-to-person phone orders, please.
Memberships extend until September 30th. Dues required for
joining for the latter half of the year, between April 1 and
Sept 30, will be one-half of the full-year amounts.
Membership Type Expires: => Sep 30 98
Individual ___ $ 50.00
Student ___ $ 25.00
Corporate Associate ___ $500.00
Corporate Member ___$1000.00
Corporate Sponsor ___$5000.00
Payment type (circle one): Check Visa MasterCard AMEX Diners
Card Account No _________________________ Expiration Date ______ EXTRA
LEGIBLE
Cardholder Name __________________________________________________ PLEASE!
Cardholder Signature _____________________________________________
You will receive email acknowledging your membership when your
registration form is processed. Thanks for joining!
