26-27 SCMA MEMBERSHIP APPLICATION

South Carolina Morticians Association, Inc.

Member of NFDMA, INC. | PO Box 1013, Laurens, SC 29360 | Visit Our Website: www.scmorticians.com
RenewalNew Member
Funeral Director/EmbalmerStudentApprentice Funeral Director/Embalmer
Full Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Format: (000) 000-0000.
Cell Phone*
Format: (000) 000-0000.
E-mail
example@example.com
YesNo
If Yes, Do You Serve In A Position?
District Number?
Funeral Home Affiliation:
Funeral Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
FUNERAL DIRECTORS/ EMBALMERS
YesNo
YesNo
Funeral Director License #:
Embalmer License #:
APPRENTICES
Funeral Director ApprenticeEmbalmer ApprenticeDual Apprentice
Apprentice License#:
Apprenticeship Period:
Supervising Funeral Director / Embalmer:
STUDENTS
School Affiliation:
Projected Graduation Date:
FEES*
prevnext( X )
FUNERAL DIRECTOR/EMBALMER
STATE DUES

$200.00



FUNERAL DIRECTOR/EMBALMER
NATIONAL DUES

$400.00



APPRENTICE-YEAR 1

$100.00



APPRENTICE YEAR 2
(Year 2 Dues Include $75.00 For National Dues)

$150.00



STUDENT YEAR 1
$25.00



STUDENT YEAR 2 UNTIL APPRENTICE
(Year 2 Dues Include State & National Dues)

$50.00



Subtotal

$0.00

Tax

$0.00

Total

$0.00
DISTRICT DUES ARE TO BE SUBMITTED TO YOUR DISTRICT WITH A COPY OF THIS FORM.
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South Carolina Morticians Association, Inc.