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MEMBERSHIP APPLICATION

To apply for membership, please fill out the following information:
Contact Name
Company Name
Address
City
State/Province
Zip
Phone
Fax
Email
Web site
Please specify type of business:

Milk Hauler

  $75/yr

State Association

  $500/yr

Allied Member

  $200/yr
Please specify type of business:

 

PLEASE PRINT THIS FORM AND MAIL IT WITH YOUR CHECK TO:

IMHA
5307 INDIGO WAY
MIDDLETON, WI  53562

March 11, 2008