MARR - Join Marr

Join MARR - Membership Application

Name:

Title:

Organization Name:

Address:

Address 2:

City:

State:

Zip:

Telephone:

Email:

Information Release:
Please place a check in each box for which you DO NOT want information published in the membership directory that is posted on the www.mi-marr.org web site.

	Name and Title		Organization		Mailing Address
	Phone Numbers		Fax Numbers		e-Mail Address

Membership Constituency:

Enter the word you see below:

By submitting this form, in as much as you subscribe to the Mission and Goals of the Michigan Antibiotic Resistance Reduction Coalition (MARR), you agree, in accepting membership in the MARR Coalition, to abide by the MARR Coalition By-laws. You certify that have read and understand the MARR conflict-of-interest statement and will act according to its tenets. Furthermore, you agree that you will not use the imprimatur of the MARR Coalition without the authorization and approval of the MARR Coalition Governing Council. You also agree to the posting of your name and contact information in the MARR membership directory, except where you specifically disallow such posting.