Membership Registration

Membership Plans

Save 40% on the 3 year plans.

Individual Memberships

Basic Member $55.00/year

Basic Member $125.00 every 3 years

Agency Memberships

Basic Agency $350.00/year

Basic Agency $699.00 every 3 years

Member Information

Email Address*

First Name*

Last Name*

Password*

Confirm Password*

Agency/Organization Information

Title

Agency/Organization Name

Category of MIH

Address Information

Street 1

Street 2

City

Country

State

Provinces and Territories

Zip Code

Postal Code

Telephone

Additional Agency Members

Only complete this section if you are purchasing an Agency Membership.

Agency User 2 First Name

Agency User 3 First Name

Agency User 4 First Name

Agency User 5 First Name

Agency User 6 First Name

Agency User 7 First Name

Agency User 8 First Name

Agency User 9 First Name

Agency User 10 First Name

Agency User 2 Last Name

Agency User 3 Last Name

Agency User 4 Last Name

Agency User 5 Last Name

Agency User 6 Last Name

Agency User 7 Last Name

Agency User 8 Last Name

Agency User 9 Last Name

Agency User 10 Last Name

Agency User 2 Email

Agency User 3 Email

Agency User 4 Email

Agency User 5 Email

Agency User 6 Email

Agency User 7 Email

Agency User 8 Email

Agency User 9 Email

Agency User 10 Email

Only fill in if you are not human

Membership Registration

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833-4-NAMIHP