2024: Convention Registration

Branch Assessment Form

Please complete this form to submit your branch assessments for the current fiscal year. The NANM fiscal year runs from September 1 through August 31. Note that assessment payments are due from all active branches by December 31st annually. You can direct inquiries about your branch assessment to our National Executive Secretary, Mr. Robert Price (Executive-Secretary@nanm.org).
Name of Branch
Region
Branch Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Does your branch have 501c3 status?

YesNo
If your branch has 501c3 status, have you filed federal taxes for the past 3 years?

YesNo

Assessment Total*

Assessment$300.00

Each branch must pay this annual assessment fee.

Adult Members$70.00

Check this box ONLY if you are paying for "Adult" members within your branch, and update the total below.

Total Adult Members
Item subtotal:$0.00

Collegiate Young Artist Members$25.00

Check this box ONLY if you are paying for "Collegiate Young Artist" members within your branch, and update the total below.

Total Collegiate Young Artist Members
Item subtotal:$0.00

Youth & Junior Members$25.00

Check this box ONLY if you are paying for "Youth & Junior" members within your branch, and update the total below.

Total Youth/Junior Members
Item subtotal:$0.00

Life Members$ Free

Check this box ONLY if you are paying for "Life" members within your branch, and update the total below.

Total Life Members
Item subtotal:$0.00

Total $0.00

Payment Information

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Branch Assessment Form