NJASA New Member Application 2012-2013
Please choose one:
Work Phone (xxx)xxx-xxxx
Work Phone Ext.
Year appointed to present position
Home Phone (xxx)xxx-xxxx
Birth Date (Mo./Date/Year)
Please provide your 2012-2013 Year Salary on the line below:
STEP 1 of 2
Please complete the Dues Calculation below and list the sum on the line provided below.
.01 x 2012-13 Salary to nearest $5 =
(minimum dues $785)
STEP 2 of 2
Total NJASA Dues = Total Sum From Above + $200
Please choose your payment method below:
For additional payment options or questions, contact Charlotte Duthie, Membership/Office Manager at 609-599-2900 ext. 127 or email firstname.lastname@example.org. A portion of your dues relates to lobbying and is not tax deductible.