NEPC Membership Application/Renewal Form

Below you will find a membership form and an invoice. The cost of your membership is $100.00 for each member from your company. This membership is valid for the NEPC calendar year Sept. 2011 through Aug. 2012. Thank you.

(Please fill-out completely)

Company Contact Person
Email
.
Business Category
.
Company
.
Description
	Company tagline or brief description of products or services
Address
City
State	Zip
Phone
Fax
Website
.
Additional Members
.
.
.

Payment Options: Credit Card Pay by Check Please Invoice

Credit Card: MasterCard VISA American Express

Cardholder's Name
Charge Amount $	($100 each member)
Credit Card No.
Exp. Date
CVC Code (on back)
. or mail to: New England Produce Council c/o Laura Sullivan 7 Gloria Circle Burlington, MA 01803 Fax: (781) 273-4154