Name: Last |
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First |
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MI |
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Company Name |
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| Address |
______________________________________________________________________________ |
| City |
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State |
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Zip Code |
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Home
Address |
______________________________________________________________________________ |
| City |
_______________________
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State |
_____________________
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Zip Code |
_______________ |
Primary Phone |
(_____) ________________ |
Fax |
(_____) ______________ |
Other |
(_____)_________ |
E-mail Address |
________________________________________________________________________
Note: Communications, including MnIPS Newsletter, will be
provided via email. |
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How did you hear about us? |
| Newspaper (___) |
Person (___ |
Name:________________________ ) |
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| Other Organization (___) |
Website (___) |
Other (___) |
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Annual Membership:
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No charge
for 2007-2008 MnIPS membership . |
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Signature ______________________________________________________________
Date _______________________________
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For Further Information:
Website: www.mnips.org
E-mail: info@mnips.org
Phone: 651.205.1357 (Kenneth Frank)
US Mail: P.O. Box 201243,
Bloomington, MN 55420-1243
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Last updated: September 18, 2007
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