Please print, complete, and mail this application to:

International Magnetics Association
8 S. Michigan Ave.
Suite 1000
Chicago, IL 60603

Application for Affiliate Membership

I.  Applicant Data

Name:        

__________________________________________________

Title:        

__________________________________________________

Organization:        

__________________________________________________

Address 1:        

__________________________________________________

Address 2:        

__________________________________________________

City:        

__________________________________________________

State/Province:        

__________________________________________________

Postal Code:        

__________________________________________________

Country:        

__________________________________________________

Phone Number:        

__________________________________________________

FAX Number:        

__________________________________________________

E-Mail Address:        

__________________________________________________

Web Page:        

__________________________________________________

II.  Affiliate Member Categories

Affiliate (Non-Voting) members shall be limited to individuals, business entities, firms or corporations with interests in the industry including, but not limited to, publications, universities and industry consultants. Please check applicable category:


     

Classification

Annual Dues
     

University

$250
     

Publication

$500
     

Consultant/Other

$1000

Name of person to represent applicant to IMA:

Name:        

__________________________________________________

Title:        

__________________________________________________

Additional Representative:

Name:        

__________________________________________________

Title:        

__________________________________________________

IV.  Nature of Business

Give a short description of the products or services you provide:

_____________________________________________

_____________________________________________

_____________________________________________

When was your company/entity established?: __________________________________

Applicant agrees, that if elected to membership by the Board of Directors, to be bound by the provisions of the IMA bylaws and to pay all IMA dues and assessments when due. Applicant further attests that the information stated in this application is true.

Signed:

__________________________________________________

Date:

__________________________________________________