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Renewal Application NLMTA 2024-2025

Please complete and submit the following electronic renewal application.

    Applying for:

    Your Name:
    Home Address:
    Town/City:
    Province:
    Postal Code:
    Phone:
    Email:

     

    Primary Workplace Name:
    Business Address:
    Town/City:
    Province:
    Postal Code:
    Business Phone:
    Business Fax:
    Do you have a secondary/additional work place?
    Secondary Workplace Name:
    Business Address:
    Town/City:
    Province:
    Postal Code:
    Business Phone:
    Business Fax:

    Year Joined NLMTA:
    Reg.# NL#:

    In an effort to better connect with all members, please indicate if you are:
    If you would like to be included on our mailing list (and are not currently receiving emails), please provide the email address that you would like us to use for such communications:

    I am interested in being nominated for an executive position:

    Would you like to volunteer with the NLMTA? Please indicate your area of interest below.

    I, the undersigned, understand that the application for renewal cannot be accepted unless it is completed and accompanied by full payment. Membership will lapse in the NLMTA and CMTNL, including liability insurance, if the application and payment is NOT received by Midnight September 15, 2024.

    Signature:


    Date:

    All payment information and options, as well as the ability to complete payment, will be provided to you on submission.