NMIA Ohio Chapter
Secure Payment Form

At the direction of NMIA National Leadership we are no longer accepting payment for national memberships. Please contact NMIA National directly at http://www.nmia.org/.

Membership Information (Complete only if paying for NMIA Ohio Local Chapter Membership)

$20 annually for Individuals & Military (Officers, E-7 and above)

$10 annually for Students, Academic Professionals & Enlisted Personnel (E-6 and below)

Membership Type:

Local Membership Type:

Member First Name:
Member Last Name:
Address Line 2:
Phone Number:
Email Address:
Status: (i.e.. active, retired, civilian, other etc.):
Credit Card Information:
Credit Card:

Amount of Payment:
Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
[What is the Card ID?]

NMIA is a 501(c)(6) Tax Exempt organization. Payments or gifts to NMIA are not deductible as charitable contribution, but may be deductible as business or professional expenses. Please consult your accountant for additional information.

Contact the NMIA Ohio Treasurer at ohionmia@gmail.com for transaction questions or problems with this form.