TNAFPM Membership Form 2010 by qKQ55N

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									      TENNESSEE ASSOCIATION OF FLOODPLAIN MANAGEMENT
                  MEMBERSHIP APPLICATION
                          Membership shall run from January 1st through December 31st
               Please complete the following information. Fees are due by January 31st of each year.


Member 1: Last Name: ______________________________             First Name: ______________________________

Job Title: _____________________________________________________________________________________

Member 2 (if Agency): Last Name: _________________________           First Name: __________________________

Job Title: _____________________________________________________________________________________

Company/Organization: _________________________________________________________________________

Mailing Address: _______________________________________________________________________________

City: ______________________________                  State: _________          Zip Code: ____________________

Business Phone: (       ) ________________________           Other Phone: (       ) _________________________

Email: _______________________________________________________________________________________

Do you wish to share your contact information with other members online?      ______ Yes         ______ No

_______ Check Here if Applying for First Time Membership                 _______ Check Here for Renewal

_______ $25.00 – Individual Membership

_______ $10.00 – Student Membership (Proof of ID-Fulltime)

_______ $40.00 – Agency Membership (Includes Two Designated Memberships)

_______ $200.00 – Corporate Sponsorship (Does Not Include Individual or Agency Membership)

_______ Check Enclosed: payable to Tennessee Association of Floodplain Management or TN AFPM

I am interested in the following: (Check all that apply)

_______ Training/Education          _______ NFIP              _______ Membership/Development

_______ GIS/Mapping                 _______ Networking        _______ Local Government FPM Requirements

Other Areas: __________________________________________________________________________________


Signature _________________________________________________                Date _____________________________

Mailing Address:                  Chairman: Alan M. Armstrong                   Vice-Chairman: William Warre
                                  razorback1@plansandmorellp.com                jwilliamwarren@bellsouth.net
TN AFPM
P.O. Box 1219                     Secretary: Cindy Popplewell                   Treasurer: William Veazey
Covington, TN 38019-2377          Cindy.Popplewell@amec.com                     tcplanning@bellsouth.net
Website: www.tnafpm.com
                                  Exofficio: Stanley Harrison stanley.harrison@tn.gov


                                    TNAFPM Membership Form v.2010

								
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