Company Name
Address
Street Address 1
Street Address 2
City
State / Province / Region
Country
Year Company Established
Website
President/CEO
Parent Company (if any)
Primary Contact (This individual will serve as the main representative for your company, ensuring that MAMA information is passed on to the appropriate person(s) and keeping MAMA apprised of any address and staff changes within your organization.)
Name
Title
Phone
Email
Secondary Contact (if any)
Billing Contact
How did you learn about MAMA? —Please choose an option—Contacted by MAMAGeneral industry awarenessNewsletterReferralOther
Type of Membership: Regular MembershipAssociate Membership
Membership Type Descriptions
Regular Membership - Available only to individual or business entity providing medical alert or telehealth systems to customers and/or providing monitoring services for such systems.
Associate Membership - Available only to an individual or business entity which does not qualify as a Regular Member but which markets systems, equipment or other services to Regular Members.
NOTE: If applying for Regular Membership, dues are based on your company’s annual gross revenue, which is self-reported and based on the honor system. An individual company's dues level will be kept confidential. MAMA reserves the right to review dues levels for accuracy and make adjustments as necessary.
Annual Gross Revenue (required for Regular Membership): Less than $5M$5M to $30M$30M to $55M$55M to 100MOver $100M
Primary interests in joining MAMA: NetworkingIn-person Meetings and EventsEducationIndustry standards and best practicesAdvocacyBusiness DevelopmentOther
Notes or questions?
