Missouri Association of Elementary School Principals
Business Associate
Membership Application
July 1, 2010 to June 30, 2011
Business Information
Company Name: _________________________________________________________
Company Address: _______________________________________________________
City: _________________________________ State: ____________ Zip: ____________
Business Phone: _________________________ Fax:
____________________________
Contact Person
Contact Name: __________________________________________________________
Address: _______________________________________________________________
City: _________________________________ State: ____________ Zip: ____________
Phone: _______________________________ Fax: ______________________________
E-mail Address: __________________________________________________________
Payment Information
MAESP Corporate Associate Dues @ $150 $ _____________
Add $50 if one set of MAESP member labels is desired $ _____________
(A set of 2010-2011 MAESP mailing labels will not be available until December 1, 2010.)
MAESP Pictorial Directory Advertising (see enclosed rate sheet ) $ _____________
Total Due: $ _____________
Method of Payment
( ) Check enclosed (payable to MAESP)
( ) Purchase Order Enclosed (No. ________________________)
( ) Credit Card VISA Card No. ______________________ Exp. Date ____________
Mastercard No. __________________________________ Exp. Date ____________
Return completed application to:
MAESP
3550 Amazonas Drive
Jefferson City, MO 65109