1999 Annual Membership Registration |
| Please type or print all information requested. |
| Name: | _____________________________________________________ | ||
| Organization: | _____________________________________________________ | ||
| Address | _____________________________________________________ | ||
| City: | ____________________ | State: ___ | ZIP: __________ |
| Phone: | ____________________ | Fax: __________ | |
| E-mail: | ________________________ | ||
| Web URL: | ________________________ | ||
Nominations of Officers |
| President Elect / Program Chair | |
| Central Director: | |
| Western Director: | |
| Webmaster: |
The 1999 annual membership fee per organization is $125.00.
The Federal Employer Identification Number for PRISM is 84-1099456.
Please mail this form with your check made payable to PRISM to:
Mr. Dennis Batchelder
PRISM Administrator
The Batchelder Group
11344 Coloma Rd., Ste. 505
Gold River, CA 95670