IAOM Membership Renewal

5001 College Blvd., Suite 104, Leawood, Kansas 66211-1618 USA
Telephone: 913.338.3377   Fax: 913.338.3553   Email: info@iaom.info

Renewal for (check one):  
Active Membership          Junior Membership          Associate Membership
   
 RENEWAL INFORMATION:  
 

* Please provide your IAOM Member ID and/or your Invoice number to ensure your membership renewal is processed correctly. *
   
Member ID:
Invoice #:
   

* Only enter contact information below if it has changed. *
   
Last Name:
First Name:
Middle Name:
Fourth Name:
Company Name:
Company Address:
Company City:
Company State:
Company Zip/Postal Code:
Company Country:
Company Phone:
Company Fax:
E-Mail:
Position in Company:
Residence Address:
Residence City:
Residence State:
Residence Zip/Postal Code:
Residence Country:
Home Phone #:
To which address do you prefer your IAOM mail delivered?
Business Address          Home Address

 

 IMEF FOUNDATION CONTRIBUTION:

  
 
$25  $50   $75  $100  Other $
 
 Contribution paid by:
Individual  Organization
 

 

 PAYMENT INFORMATION:

  
 
* You must choose a card type below *
VISA          MASTERCARD          AMERICAN EXPRESS  DISCOVER 
Card #:
Expiration Date:
Name as it appears on card:

I, the undersigned, do hereby make application for membership, and agree to comply with all laws, rules, and regulations of the IAOM. I hereby tender $  in US funds drawn on a US bank (Active or Associate - $195 Junior Active - $30), to be returned to me if my application is rejected. I agree to pay annual dues in like amount, or such sum as may be established by the Board of Directors in the future.

Signature  Date 

Mail application form with Check or Money Order (in U.S. funds, drawn on a U.S. Bank), made payable to: IAOM, or use American Express, Discover, MasterCard, or Visa credit card.

Revenue ACT (H.R. 3545), Section 10701 (a) Remittances to the IAOM are not deductible as charitable contributions for federal USA income tax purposes. However, dues payments are deductible by members as an ordinary and necessary business expense.

 
 

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International Association of Operative Millers
5001 College Blvd., Suite 104, Leawood, Kansas 66211 USA • Phone: 913 338-3377 • Fax: 913 338-3553 • info@iaom.info