Affiliate Membership Application

As a UMACHA member, you will receive the ACH Rules, electronic and paper newsletters, workshop/webinar schedules, publication lists and other information to assist you with your ACH program.
Complete the form below to become a member of UMACHA and take advantage of all the member benefits. We use email as a primary source of delivery so you receive up-to-the-minute information. Please remember to let us know whenever you have changes in your contact information so you continue to receive all of the updated information UMACHA sends.

Company Information

Company Name
Address
City State Zip
County
Work Phone Fax Toll Free
Web

Primary Contact

First Name Last Name
Title
Email
Direct Dial Mobile

Membership Dues

Select Dues Amount
By submitting this application, our company agrees to pay the current annual membership fee of $300 to UMACHA. I verify that I am an authorized representative of the company.
  (please initial here)

Other Contacts

1st Contact
Name
Title
Email
Phone

2nd Contact
Name
Title
Email
Phone

3rd Contact
Name
Title
Email
Phone
NOTE: If you have additional contacts at your organization, please notify the UMACHA office so they can be added to the database.
   - denotes required fields