Professional Membership Form

Professional Membership Form

 

Name
Date of Birth
Phone Number
Address
City
State
Zip
Email
Employer
Job Title
Work Phone
Work Fax
Responsibilities
Areas of Interest or Expertise?
Would you be willing to volunteer some time to help NYFAC in any of these areas?
Available times?
Would you recommend any of your colleagues for membership?
*Please note that by clicking submit, you agree to paying $50 per year for registration with NYFAC.*

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