Full Name of Organization

Number of Employees

Address

City

State

Zip

County

Area Code/Phone

Fax

Website

Dues (prorated)

$ Annual dues

Industry/Product Description

SIC Code #

1. Member Needs:

Please state your reasons for joining The Management Association, and check specific needs below.

Reasons For Joining

Specific Needs

Affirmative Action Plannning
Benefits Assessment
Compensation System Design
Employee Handbook Assistance
Employment Opinion Survey
Employment-Related Legal Services
Human Resources Compliance Audit
Job Descriptions/Job Grades
PHR/SPHR Study Course
Training for Supervisors/Managers
Union Avoidance/Relationships
Interim HR Services
Organization Development Consulting
Coaching
Teams
Surveys
Other:

2. How did you hear about us?

3. Do you have other locations in Illinois? Where?

4. Method of payment:

Invoice
Credit card

5. Authorization:

Upon approval, you will receive a membership census to provide us with additional information about your organization.

Name of Main Contact

Title of Main Contact

E-mail