Please enclose a copy of this invoice with your payment.

eMarketing Association
4259 Old Post Road - Charlestown, RI 02813

PHONE: 401.315.2194 FAX: 408.884.2461
REFERENCE # PM01 - INVOICE

1 PROFESSIONAL MEMBERSHIP For a period of 1 YEAR - $175.00

Please provide the following: Date__________________

Member Name__________________________________________________________________

Address________________________________________________________________________

City______________________________________State_______________Zip_______________

Company:______________________________________________________________________

Company URL:__________________________________________________________________

Phone #:______________________________________ Ext.:____________________________

Email Address___________________________________Years of Marketing Experience: ______

Payment Method:

Visa ___ MasterCard ___ American Express___ Check___

Card Number_____________________________________________Expiration ______________

If Different From Above:

Name On Card__________________________________________________________________

Address________________________________________________________________________

City______________________________________State_______________Zip_______________

Signature:______________________________________________________________________

Mail a copy of this invoice with your payment to the address above. or fax it to: 408.884.2461
You will receive an email confirmation of this order and a members welcome package within 2 weeks.