Date: _______________________


Company:  ________________________________________________________________________

Address:  _________________________________________________________________________

  ________________________________________________________________________________

City: _____________________________________________________________________________

State or Province: ___________________________________________________________________

Zip: ________________________ Country: ______________________________________________

Contact Name & Title: _______________________________________________________________

   _______________________________________________________________________________

Phone: ___________________________________________________________________________

Email: ____________________________________________________________________________


Membership categories and annual dues (All amounts in US $):

Molded Fiber Product Manufacturers & Suppliers: .......................................................................$1095.00
Molded Fiber Products User ...........................................................................................................$50.00
Governments/Institutions/Universities & Associations: ..................................................................... no fee


Credit card number: ________________________________________ Type: ____________________
(Master Card or Visa only)
Payment to IMFA 1425 W Mequon Road, Mequon, WI 53082 or
FAX: 262 241-3766      


Bank Transfer to: Ozaukee Bank, Cedarburg, WI 53092 USA
ABA-075-912-233


please make a copy for your records