MIT Enterprise Forum of NYC Membership Application/Renewal Form

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Fill out this form, print it out and return it by either mail or fax (212-286-9036).
MIT Enterprise Forum of NYC, 317 Madison Ave., Ste 1900, NY, NY 10017
I would like to: Join Renew my membership Continue to receive notice of events.
Payment: Please apply to my credit card I am enclosing a check for $100 payable to MITEF
Name (as it appears on credit card):
Credit Card Num./Exp. (MM/YYYY):        /
Title:
Company Name:
Business Address:
Business City:
Business State/Zip:
Business Phone: Fax:
Business E-Mail:
Home Address:
Home City:
Home State/Zip:
Home Phone: Fax:
Home E-Mail:
How do you prefer to receive our newsletter and other announcements? Please check one:
Mail to Business Mail to Home E-Mail at Business E-Mail at Home
Please indicate which committee(s) you would be interested in. (Check up to two):
Bus. Plan Presentation Bus. Builder Event Digital Media Events Marketing Commun. Web Site
Please tell us your professional business category (Check the ones that most closely apply):
Financial Services (Corporate/Commercial/Institutional Finance/Investment Banking/Venture Capital)
Corporate Services (Accounting, Law, Consulting, Executive Search, Marketing/Advertising/PR)
Industry (Manufacturing, Telecom, Healthcare/Biotechnology)
Media (Internet/Software, Publishing, Broadcasting)
Other (Specify)
Check here if you own your own business
Please list me in the membership directory.