Michiana APICS Mail Notification Request

Michiana APICS Chapter Member Mail Notification Request
Receive notice of all New or Upcoming Events via E-mail.

	Yes No I'd like to be contacted on membership if not a member?
Yes	I'd like to receive e-mail notices. No, I'd like to discontinue receiving e-mail notices
Member ID:	What Chapter:
E-mail:
	This is a Personal or Work email address?
First Name:
Last Name:
Title:
Organization:
Address:
Address (con't)
City:
State, Zip:	Zip +4 if at all possible, please
Phone- Work :	Home:
Fax:
	Are you currently a Company Coordinator? Yes No... but I'd like to become one
Comments?:

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