NYSAC Membership Dues NYSAC Membership Dues Voting Member Name * First Name Last Name * Last Name Title (Optional) Title Voting Member Dues Based on Number of Interments Yearly (Check One) * 0-24 – $16.00 25-49 – $48.00 50-299 – $113.00 300-499 – $187.00 500-799 – $396.00 800-1,399 – $734.00 1,400-1,999 – $903.00 2,000 – Over -$1,073.00 Crematory Member – $169 plus interment fee dues Supplier Member – $283.00 Associate Member – $45.00 Cemetery Name / Organization * Street Address * Address 2 City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Email * Phone Number * Fax Please select one membership category * CemeteryMemorializationMaintenanceConstruction/DesignAccountingInvestmentLegalTechnologyInsuranceFinancial ManagementConsultingMarketingOther Please select one membership category Membership Dues Schedule Supplier Members Supplier Members: Please list product or service marketed Cemetery Members Year of cemetery inception Cemetery acreage Exact number of interments last year Associate Members at $45.00 each. (Same benefits as voting member.) Please select the number of Associate Members One +$45.00 Two +$90.00 Three +$135.00 Four +$180.00 Five +$225.00 Six +$270.00 Seven +$315.00 Eight +$360.00 List the Names of the Associate Members List the Names of Email Addresses for Associate Members Payment Information Additional contribution to support your Association Pay by I will be paying by Credit Card/Paypal Online I will be paying by check Total Due $ * If you have any questions please call the NYSAC office at (518) 434-1134. This information will be listed in our membership directory and on our website. Please make checks payable ONLY to: New York State Association of Cemeteries. Please do not use acronyms such as NYSAC. *The information submitted will be available to membership online and in the NYSAC publications, unless requested otherwise. Mail form and payment to: New York State Association of Cemeteries 111 Washington Avenue, Suite 501 Albany, NY 12210 Phone (518) 434-1134 Fax (518) 427-0452 firstname.lastname@example.org www.nysac.com If you are human, leave this field blank.