Municipal Services Association

 MSA MEMBERSHIP REGISTRATION FORM 
(Please print this form and mail in as instructed at the bottom of form)

A. CONSECUTIVE ANNUAL MEMBERSHIP RENEWAL ASSESSMENT  $220.00	_________

or B. NON CONSECUTIVE OR NEW MEMBERSHIP ASSESSMENT   $320.00  	_________

(ALLOWS TWO REPRESENTATIVES)				 

 ______ EACH ADDITIONAL REPRESENTATIVE - $110.00  PER YEAR	_________

					TOTAL		_________

PLEASE MAKE CHEQUE PAYABLE TO THE MUNICIPAL SERVICES ASSOCIATION.  

YOUR RETURNED CHEQUE IS YOUR RECEIPT AND ACKNOWLEDGEMENT OF MEMBERSHIP. 

NOTE:  THIS IS YOUR ANNUAL MSA MEMBERSHIP.  It is NOT your PWABC Conference 
registration fee, that will be collected by PWABC at the time of Conference 
Registration.

	NAME OF REPRESENTATIVE ___________________________________________________

	NAME OF REPRESENTATIVE ___________________________________________________
	FIRM _____________________________________________________________________
	ADDRESS __________________________________________________________________
	CITY _____________________________________________________________________

	POSTAL CODE _______________________   
	CONTACT PERSON ___________________________________________________________
	PHONE ________________________ FAX ______________________ 
	EMAIL __________________________________________

PLEASE STATE NAME, ADDRESS, DEPARTMENT, PHONE AND FAX NUMBER OF THE PERSON TO WHOM
NEXT YEAR’S ASSESSMENT NOTICE SHOULD BE MAILED TO IF DIFFERENT FROM THE ABOVE.
For further information, contact: