Cap membership Application
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- Navigate this page:
- Descriptor for NHMS Web Site CAP Guide
- Newsletter Highlight 75 words or less __________________________________________ ________________________________________________________________
- If you would like to write your own CAP of the Week item (100 words or less) ________
- ________________________________________________________________________________________________________________________________
CAP Membership Application Name of business or firm: _____________________________________________________ Primary contact person: _______________________________________________________ Title: ______________________________ Email: _________________________________ Mailing address: _____________________________________________________________ City: _______________________ State: ____________________ Zip code: _____________ Telephone #: (____) ______________________ Fax #: (_____) _______________________ Website: ___________________________________________________________________ References: _______________________________________________________________________ Please list other staff who should receive our mailings (maximum three): Name: ___________________________________________________________________________ Title: ____________________________________________________________________________ Email: ___________________________________________________________________________ Name: ___________________________________________________________________________ Title: ____________________________________________________________________________ Email: ___________________________________________________________________________ Name: ___________________________________________________________________________ Title: ____________________________________________________________________________ Email: ___________________________________________________________________________ With this application, please include the annual CAP fee of $1250.00, payable to “NHMS.” If your application is denied, your check will be returned. Please complete the back of this form with more information about your company. Please e-mail a brief description of the services your company provides for use in our e-Update CAP of the Week to: joy.potter@nhms.org. You are welcome to enclose brochures or other promotional materials with this application. Please sign and return both the application and the Limitations form to NHMS at 7 N. State St., Concord, NH, 03301. ______________________________________________________________ ____________ Applicant Signature Title Date Descriptor for NHMS Web Site CAP Guide ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Newsletter Highlight 75 words or less __________________________________________ ________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ If you would like to write your own CAP of the Week item (100 words or less) ________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________ If someone other than the principal listed on the front is responsible for billing, please list the information here ____________________________________________________________ __________________________________________________________________________ Directory: sites -> default -> files -> Pdfs files -> Occupational health and safety files -> The Black Panther Party’s Ten Point Program files -> International programs roel profile files -> Fermi Questions a guide for Teachers, Students, and Event Supervisors Lloyd Abrams, Ph. D. DuPont Company, cr&D/ccas experimental Station Wilmington, de 19880 files -> Personal Information Name: Maha Al-Ammari Nationality: Saudi Relationship Status Pdfs -> Prepared by John Findlay & Abby Straus Maverick & Boutique Pdfs -> - Pdfs -> Executive Summary Prepared by John Findlay & Abby Straus Maverick & Boutique Pdfs -> LibraryLinknj mobile Project 2013-2014 New Jersey Libraries-On-The-Go Project Launch Download 8.02 Kb. Share with your friends:
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