MTAM Student Membership Application

* Indicates required questions
Students can gain experience, contacts, and career information by being part of MTAM. To receive your complimentary 1-year Student Membership, please complete the form below.
Name *
First
Last
Email *
Mobile Phone # *
Address *
City *
State *
Zip/Postal Code *
-
School Name *
School Location - City *
Grade Level *
Freshman
Sophomore
Junior
Senior
How were you referred to our organization? (check one) *
Website
Meetup Group
Twitter
LinkedIN
Facebook
Personal Referral
Mobile Monday
Search Engine
Automation Alley
Small Business Assn of Michigan
Other - Please specify:
Do you wish to make your contact information available to MTAM members who wish to provide you with services, information or opportunities? *
Yes No
Do you wish to make your contact information available to non-MTAM members who wish to provide you with services, information or opportunities? *
Yes No
Username *
VerificationCode
Enter code in image:

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