Membership Registration Form

RETAIL ADVERTISING & MARKETING ASSOCIATION
On-line Membership Form

NRF Members may join RAMA at no additional charge. Please let us know you are interested, and a membership representitive will contact you within 48 hours.

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Part I Please fill out registration form completely.

Contact Name:

Title:

Company:

Address:

City:
State:
Zip:

Country:

Phone:

Fax:

E-mail:

Website:

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This Section Must Be Completed

Membership Type

Individual
Corporate (Please provide two more contact information below)



Contact Name 2:

Title:

Email:

Phone:

Contact Name 3:

Title:

Email:

Phone:

Type of Company

Retailer
Agency
Media (newspaper, television, radio, cabletelevision, magazine)
Service Provider
Shopping Center
  Other

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Part 3 Payment Method

Date: Total Due:

Payment Method
(EIN # 13-5582627) Amex
Diners Club
Discover
MasterCard
Visa
Check

Card Holder's Name:

Card Number:

Exp Date:

Billing Address:

City:

State:    Zip:

PAYMENT INFORMATION:

• Payments: Must be in US dollars drawn on a US bank. If paying by check, please make payments payable to the Retail Advertising Marketing Association/NRF. P.O.Box 90870, Washington, DC 20090-0870

• For further information: Please contact Peter Perweiler at 202.661.3052 or e-mail PerweilerP@rama-nrf.com.