NEW YORK STATE EMERGENCY MANAGEMENT ASSOCIATION
2012 MEMBERSHIP APPLICATION


Membership Dues: $50.00 Per Applicant

Membership Year: January 1, 2012 - December 31, 2012

Once the form is submitted you will be need to print
a copy of the invoice to send in with your payment.
Your invoice will be displayed after clicking Submit.
*NYSEMA DOES NOT ACCEPT CREDIT CARDS*
Date of Application:
   
Applicant Name:
Applicant Title:
   
County/Town/Village:
City/Agency:
Work Street Address:
   
Email-Address:
   
Phone:
Fax:
Cell:
   
Number of Years as NYSEMA Member:
Number of Years affiliated with NYSEMA: