CMLA/NMSA Membership Application

 The individual completing this form will be considered the contact person and advisor for the student organization.

 Collegiate Advisor:                                                                              

College/University:                                                                               

Address:                                                                                  

City:                                           State:                Zip/Postal Code:                                

Country:                                  

TEL (W): (        )                      (H): (        )                              Fax: (        )                            

List 3 names/titles of student officers or other individuals to receive benefits/voting privileges:

1.                                               2.                                             3.                                          

Collegiate Membership (check one)

□  USA- $199                        □  International- $234

Total Amount Enclosed:                                   

Type of Payment (check one)

□  Purchase Order (must accompany this form)     □  American Express

□  Check (payable to NMSA in US funds)            □  Master Card

□  VISA

Card Number:                                                                          Exp. Date:                               

Card Holder Name:                                                                  Signature:                                

Send to: National Middle School Association, 4151 Executive Parkway, Suite 300, Westerville, Ohio, 43081