NEPA MAEA Membership Form

Company Name(Required)

Company Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

County(Required)

Phone(Required)

Fax

# Full-time Employees(Required)

# Part-time Employees(Required)

Manufacturer?(Required)

Yes

Union?(Required)

Yes

Corporate headquarter location

Describe products/services offered by your company(Required)

Link to my company website

Is it OK to publish your website in your listing?

Yes

Suggestions for future programs or events you would like to see

Are you marking any special occasions (anniversary, groundbreaking, award)?

Contacts at your organization

Name	Actions

There are no Contacts.

NOTE: You are allowed up to 6 contacts from your organization. Each person can have their own interests and subscriptions for MAEA information.

Please be sure to click the “SUBMIT” button below to send your application to us. Thank you for taking the time to complete the process. We will contact you to finalize the process.