The Ad Club of Western Massachusetts

Membership

Application

To become a member, complete the form below and send us a check for $100 payable to the Advertising Club of Western Massachusetts. Do you know someone else who should belong? Send us their name and number.

In the form below, fields with an asterisk (*) next to them are required.


*Membership Type new membership renewal
Type the information below as you wish it to appear in the member directory.
*Company:
*Type of Company:
*Street Address:
*City:
*State:
*Zip:
*Phone:
Fax:
Website:

*1. Name:
*Title:
*Email:

2. Name:
Title:
Email:

3. Name:
Title:
Email:

4. Name:
Title:
Email:

5. Name:
Title:
Email:

Membership Category Student - $35 Individual - $100 Corporate - $500
Make checks payable to: Advertising Club of Western Massachusetts Post Office Box 2823 Springfield, MA 01101
Additional Info: