Sustaining Member Application / Renewal

This form is only for those companies applying / renewing for joint Sustaining Membership in the Microscopy Society of America AND the Microanalysis Society. Others should return to the membership page to select the most appropriate membership type.

Fields that are required are marked with an *.

Company Name: *
Submitter's e-mail address: *
My company is a:	Select One Renewing member New member
If renewing, enter your MSA or MAS ID number(s) here:
Name of contact at the Sustaining Member institution to whom we should send a payment confirmation: *
E-mail address for this person: *
Name of contact at the Sustaining Member institution to whom invoices should be sent: *
E-mail address for this person: *
Phone number for this person: *
For MAS use, please provide Sales Contact(s): *
E-mail address for this person: *
Phone number for this person: *
Company Mailing Address: *
City: *
State: *
Zip/Postal Code: *
Country: *
Company Fax Number:
Company Web Site:
Brief summary of products or services:

Sustaining Members may designate up to three individuals to receive regular MSA/MAS correspondence at no charge. Please list those individuals below:
Contact Name:	Email Address:	Phone Number:
*	*	*

We would like to receive complimentary subscriptions to the scholarly journal, Microscopy and Microanalysis: *	Yes         No
If yes, please send journal to the attention of (enter name of individual here):
Payment Type
Please indicate the method of payment: *	Select One Credit Card Check Bill Me
Sustaining Members will be contacted by both Societies for payment, or will send invoices to the invoice contact identified above (as appropriate). Questions regarding this process may be directed to:       MSA: (703) 234-4089, jheavrin@microscopy.org       MAS: webcontent@microanalysissociety.org Thank you for your support of MSA and MAS!
Enter the text above: *