Branch Assessment Form
Please complete the form below. The NANM fiscal year is September 1 - August 31. Note that payment of assessments are due from all active branches by December 31st each year. You can direct all inquiries about your branch assessment to our National Executive Secretary, Ms. Dorothy Canady (firstname.lastname@example.org).
Name of Branch
Central Region: residents of IL, IN, IA, MI, MO, NE, ND, OH, SD, and WI
Eastern Region: residents of CT, DE, ME, MD, MA, NH, NJ, NY, PA, RI, VT, VA, and DC
Southeastern Region: residents of AL, FL, GA, KY, NC, SC, TN, WV
Southwestern Region: residents of AR, CO, KS, LA, OK, MS, NM, TX
Western Region: residents of AK, AZ, CA, HI, ID, MT, NV, OR, UT, WA, WY
Branch Mailing Address
Street Address Line 2
State / Province
Postal / Zip Code
Does your branch have 501c3 status?
If your branch has 501c3 status, have you filed federal taxes for the past 3 years?
Term of Office
Use the excel worksheet found on the NANM website to upload the current information about the members of your branch. You may attach and upload the completed document here.
Enter Payment Amount
( X )
Credit Card Number
Should be Empty: