Supporter Registration

Step 01

Step 02

First Name*

Middle Name

Last Name*

Name of Business*

Address*

City*

State/Region*

Zip/Postal Code*

Email address*

Business Phone*

Step 03

Type of Business*

In Business Since*

Legal Form Under Which Business Operates* Corporation Partnership Proprietorship

If Division/Subsidiary, Name of Parent Company

In Business Since

Step 04

Type of Products and Services Offered*

HAMA Member References

Contact Name*

Contact Phone*

Contact Email*

Company Name*

Services Provided*

Length of Service*

Address*

Contact Name*

Contact Phone*

Contact Email*

Company Name*

Services Provided*

Length of Service*

Address*

Contact Name*

Contact Phone*

Contact Email*

Company Name*

Services Provided*

Length of Service*

Address*

Candidate Certification

I hereby certify that, to the best of my knowledge, the information contained herein is complete and accurate. I understand that a false statement may disqualify me from the sponsorship program. This information has been furnished with the understanding that it is to be used to determine ability and authority to advertise with HAMA. Furthermore, I hereby authorize the HAMA to contact the HAMA member references listed in this application to verify my business credentials which I am using to apply for this service.