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Annual-Chapter-Dues-Worksheet

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					           NMA ANNUAL CHAPTER                                                          Headquarters Only
           DUES WORKSHEET                                                          Date Rec:
                                                                                   Check #:
                                                                                   Chk. Amt.
Please complete the green and blue areas. The totals will
                                                                MONTH FISCAL YEAR ENDS:
                 be calculated for you.
 DATE:                                                                           CHAPTER #:




                                               NAME OF CHAPTER

                                                                # MEMBERS                       TOTAL $ AMT
1 New members who joined during the first 6 months of
                                                      +              0         @     $35.00          $0.00
  chapter's fiscal year
2 New members who joined during the last 6 months of
                                                      +              0         @     $17.50          $0.00
  chapter's fiscal year
3 Substitutions who were never a member of NMA              +        0
4 *TOTAL REGISTRATION FEES LISTED FOR ALL
  NEW MEMBERS ON LINES 1, 2, AND 3
                                                                     0         @     $20.00          $0.00
  *A registration fee of $20 per new member is required
  for those who have never been affiliated with NMA
5 Members Renewing                                          +        0         @     $35.00          $0.00
6 Former members reinstated during first 6 months of
                                                            +        0         @     $35.00          $0.00
  chapter's fiscal year
7 Former members reinstated during last 6 months of
                                                            +        0         @     $17.50          $0.00
  chapter's fiscal year
8 Substitutions who were previous members of NMA            +        0
   TOTAL MEMBERS REPORTED ABOVE (LINES 4-8)      0
                      TOTAL OWED NMA ON THIS REPORT (PAY THIS AMOUNT)
                                                                                                     $0.00
                                                   (total lines 1,2,4,5,6,7)
Name of Chapter
                                                                                       Phone:
Secretary:
Email address
Chapter Sec:
PLEASE NOTE: Complete the Membership Worksheet (tab at bottom) listing anyNew Members, Reinstated
Members, Deleted Members, Renewals, Address Changes, and/or Name Changes you have had during the
month you are reporting.

If this is your annual renewal, an invoice was sent to you for dues based on the last number of members you
reported to NMA. Please complete this worksheet to calculate your actual dues owed to NMA. We will make
adjustments to your invoice as necessary. You have 3 options to submit your dues:
1. Complete the worksheet and email both forms back to NMA and snail mail your check separately.
2. Complete this worksheet and snail mail both the invoice and worksheet along with your check to NMA.
3. Complete the worksheet, email both the bowksheet and invoice to NMA, and use your online banking to submit
   your dues.
   Snail mail to: Membership Records, NMA, 2210 Arbor Boulevard, Dayrton, OH 45439.
   Email to: robin@nma1.org
           Any questions should be addressed to Robin Furlong at 937-294-0421 or robin@nma1.org.

   Comments:
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Name           Address and Email Address    NC-Name Change
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Name           Address and Email Address    NC-Name Change
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Name           Address and Email Address    NC-Name Change
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Name           Address and Email Address    NC-Name Change
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Name           Address and Email Address    NC-Name Change
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Name           Address and Email Address    NC-Name Change
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Name           Address and Email Address    NC-Name Change
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Name           Address and Email Address    NC-Name Change
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posted:4/7/2011
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