Affiliate Membership Application

Instructions

The Affiliate membership term is based on a calendar year from January 1 through December 31 and is non- transferable non-refundable.

Select Your Option(s)

WeSERV Affiliate Membership

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameOffice Name

Please select a valid membership option and fee item if exist

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