DMA Web Community - Member application

Welcome to the DMA Web Community!

Please fill out the form below to select your "user name" and become a registered DMA Web Community member. Your user name will give you access to password protected "Members Only" features soon to be introduced on the Chapter pages of your National website, dma-national.org. Membership is free for all active (and current*) members.

NOTE: DMA Community Member user names are "unique" and will be issued on a first come first serve basis. If your request is not unique, the National Webmaster's office will add a random numeral to make it so. Your password will be issued by the National Webmasters office and sent to the mail address on the form below. Any required editing of your user name will also be noted in this correspondence.

Member Name:

I am a member of DMA Chapter #

Since

Daytime Phone:

Fax:

Everyday Email Address:

DMA Web Community User Name**	NOTE: Names are case sensitive, no spaces.
To be used to access Member's Only Features on the National Website**

Mail Address: (THIS ADDRESS IS FOR IMPORTANT CORRESPONDENCES FROM THE NATIONAL WEBMASTER)

Address

City

State

Zip

Comments:

Note: Your comments will be sent direct to the Webmaster via email however, they will not appear on the following conformation form.

Please check this box if this is a corrected form.

* Web Community Members must be current with all Chapter and National dues to participate.