• New England Moxie Congress Membership Form

  • Instructions:
    All users must enter today’s date and the name and email address of the Primary Contact.*

    For New Member application, fill in the form and select membership category in the Payment section below.

    For Family memberships, one additional name and email address may be entered where indicated. “ Family” is defined as two or more related
    individuals residing at the same address.

    For Business memberships, enter the primary contact’s name and email address, and the name of the business where indicated.

    For Annual Dues payment or upgrade to Life membership, primary contact name only is required. Note that yearly memberships are good until the end of the following calendar year and must be renewed or upgraded before that time in
    order to insure membership continuity.

    For Data Change only, enter all the contact information which has changed (address, email, phone number, etc), then hit "Submit". Do not enter any
    payment information.

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  • If this is a Data Change only (no dues payment), after completing the above form as applicable, go directly to “submit’ on the bottom of the page.  Do not fill in the remainder of this form.
     
    If you prefer payment by check, fill in the form above only  and  do not select any payment options below,  hit Submit and send a check for the appropriate amount* to:
    NEMC Membership
    attn: Judy Gross
    17 Goodhue Lane
    Barre VT 05641
  • prev next ( X )
    Membership (Individual) <$1.00 surcharge for CC Payments> One year membership $10, Lifetime membership $100
    $ 11.00
    Membership (Family) <$1.00 surcharge for CC Payments>
    $ 16.00
    Membership (Business) <$1.00 surcharge for CC Payments>
    $ 26.00
    Total
    $ 0.00
  • Should be Empty:
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