IAMU -

Review the 2012 membership options

1. Begin the registration process by completing the contact information listed below:

Organization Name
Company Website

Key Contact (For customer contact)	First Last
Title
Street Address
P.O. Box
City State & Zip
Phone
Fax
Email

Other contact for IAMU marketing information (if different than above)	First Last
Organization (if different than above)
Title
Street Address
P.O. Box
City State & Zip
Phone
Fax
Email

2. Review the 2012 membership options and mark your selection where indicated below:
(See the 2012 associate membership brochure for details of benefits)

Bronze Membership Cost..............................................................$360

Silver Membership Cost................................................................$665

Gold Membership Cost..................................................................$975

3. Please indicate your business' PRIMARY product and/or service offered.

4. Please List any ADDITIONAL products and services your business offers. These will be shown at the foot of your online listing.

5. Gold Membership Purchasers - Please enter information about your company and/or your products and services (one paragraph, maximum 200 words.)

GOLD and SILVER associate members: Please email your logo (JPG format, if possible) as soon as possible to:
John Burnett
jburnett@iamu.org
(Your logo will be displayed as part of your directory listings)

Package Options	Quantity	Price	Total
Bronze Membership		$360
Silver Membership		$665
Gold Membership		$975
Grand Total Due (All applicable sales tax has been included)

This is your invoice. No statement will be mailed.

IAMU now accepts payment by credit card. To pay by credit card, please enter a phone number where an authorized representative of your company can be reached to obtain necessary information. A representative of IAMU will call this number.

Please enter phone number for credit card payment here:
(this phone number is only necessary if you are paying by credit card.)
(Please note: A $15 fee per transaction will be assessed for credit card purchases.)

If not paying by credit card, you will be invoiced upon receipt of this registration form.

Contributions or gifts to IAMU are not tax deductible as charitable contributions for income tax purposes

IAMU's mission is the betterment of municipal utilities in the state of Iowa. In extending associate member privileges to a business, it is implied and understood that said business will also strive for the same. IAMU retains the right to deny or discontinue associate membership for a business if its objectives or practices are deemed by IAMU to be contrary to the best interests of the association and its member utilities.

Iowa Association of Municipal Utilities

To support and strengthen Iowa's municipal utilities