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Membership Application

Visit us again: at www.mma1.org or www.millionmemberassembly.com. Contact us and E-mail us at: mma1@mma1.org or  mma@millionmemberassembly.com

Please print this page and place it in an envelope and mail it with your contribution to:                                                                     Million Member Assembly                                                                                                                                                                                        Membership Application                                                                                                                                                                                       P. O. Box 1052 New York, NY 10150-1052                                                                                                                                                    Make your check payable to: Million Member Assembly

For in-kind donation and comments, please mail this form to:                                                                                 Million Member Assembly                                                                                                                                               In-kind Contribution Dept.                                                                                                                                           600 West Oak Ridge Road, Suite B                                                                                                                        Orlando, Florida 32809


Please identify and describe yourself:

Name
Sex Male Female

Please provide the following contact information:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
Web site (optional)

Please share your interest with us

Category

Please register for any community workshops:

DATE

WORKSHOP DESCRIPTION & LOCATION

Choose one of the following membership options:


Select any of the following options that apply:

Conferences, Seminars, Workshops, Lectures, Events
Travel to Haiti / Africa with MMA
Support MMA missions in Haiti / Africa
Develop group meeting for MMA in my community

I want to support MMA with a donation of $:


Submission Date


Please share your opinions with us.



Please print this page and place it in an envelope and mail it with your contribution to:                                                                     Million Member Assembly                                                                                                                                                                                        Membership Application                                                                                                                                                                                       P. O. Box 1052 New York, NY 10150-1052                                                                                                                                                    Make your check payable to: Million Member Assembly

For in-kind donation and comments, please mail this form to:                                                                                 Million Member Assembly                                                                                                                                               In-kind Contribution Dept.                                                                                                                                           600 West Oak Ridge Road, Suite B                                                                                                                        Orlando, Florida 32809


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