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HOME > Join MESDA > Register
*Organization name:   
*Street address 1:   
Street address 2: 
*City:   
County:
*State:    
*Zip:   
*Contact name (first):   
Contact name (middle): 
*Contact name (last):   
*Title:   
*Telephone:   
Fax: 
*E-mail:   
URL: 
Description of organization: Only MESDA Members will have their organization description published in the Industry Directory
 
*Categories this organization will be listed under:
(hold Ctrl key to select multiple)
 
*Computer languages this organization will be listed under:
(hold Ctrl key to select multiple)
I am registering:
To be listed in the Industry Directory or to update my listing (Skip the following section)
To be a member of MESDA (Please fill in the following information)
Payment options Total Membership Amount:
$  
Payment Method:

Account Number:
 
Name on account:
 
Billing address:
 
Expiration date:

Card Verification number**:

If you prefer not to submit your credit card information over the Internet or want to pay by check, please send the completed membership and your payment, (make checks payable to MESDA), to: MESDA, 506 Main Street, Westbrook, ME 04092.

Please send a paper invoice for payment.
I am sending a check via mail.

**This is the 3 digit non-embossed number printed on the signature panel on the back of the card immediately following the Visa or MC card account number or the 4 digit, non-embossed number printed above your account number on the face of your American Express card.
 MESDA is now TechMaine  506 Main Street, Westbrook, Maine 04092   T | 207.857.3003   F | 207.857.3029    | info@mesda.com   | © 2008 |  Privacy

 Technology Association of Maine - Connecting Technology, Community & Education