2020 Associate Member Application

• Company Name*
• Contact Person*
  This name will appear in the company listing in our online RESOURCE DIRECTORY.
  First Last
• Email*
  Enter Email Confirm Email
• Phone*
• FAX
• Website
• Billing Address*
  Please use the address associated with debit/credit card.
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
• Mailing Address differs from Billing Address
  • Yes
  • No
• Street Address (Mailing)
• Address Line 2 (Mailing)
• City, State, Zip (Mailing)
• #1: 2020 Calendar Year Associate Membership Dues*
  Please select desired membership level from the options below. All levels include a listing of company contact information on MRWA's online Resource Directory. For a breakdown of what each level receives, click the pdf form to the right.
  • Gold (includes #2 & #3) $4,700.00
  • Silver (includes #2 & #3 ) $3,600.00
  • Bronze (includes #3) $2,900.00
  • Basic $375.00
• #2: Full color rotating banner ad on MRWA website & logo/link in MRWA e-News Update e-newsletter. Goes to over 4,000 email accounts bi-weekly. (included in GOLD & SILVER Packages)
  $600.00 - PLEASE PROVIDE WEBSITE BANNER AD SIZE 470 X 70 and COMPANY LOGO OF AT LEAST 600 X 600. (Logo size listed is minimum.)
  • Yes (Banner Ad)
  • No (Banner Ad)
• #3: Link to your website on MRWA's award-winning website
  $250.00
  • Yes (weblink)
  • No (weblink)
• #4: Early Bird Special*
  Click yes if the date today is before January 31, 2020 and save $25.00 off the regular membership rate.
  • Yes
  • No
• Categories
  Please input 2 categories (3 for Gold Level) in which you want your listing to appear.

  Column 1	Column 2	Column 3

• Choose from the categories listed at the bottom of the page.
• Credit Card
  American Express

  Discover

  MasterCard

  Visa

  Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date   Security Code Cardholder Name
• Total
  $0.00
• Please mail or email your business card to us once the form has been submitted.