HOW TO JOIN REGFORM

Joining REGFORM is simple. Complete this form and submit it or email Kevin Perry at kperry@regform.org for a paper copy. When we’ve received your information, we’ll send you a new member welcome package and an invoice for membership dues. Please call (573) 761-9313 if you have any questions. Congratulations on your decision to join REGFORM!


Make the Decision to Join

Tell Us About Your Organization

Designate a Primary Contact

Each member company designates a primary contact person who acts as the company representative to REGFORM and votes as a member of the REGFORM Board of Directors. Please tell us about your designated primary contact person:

Name

Title

Mailing Address

Street Address (if different)

Telephone

E-mail Address

Designation of a primary contact person at your company does not restrict participation in REGFORM by your company’s other employees. Tell us about others at your facility who will participate.

Name Other Contacts

Would you like others in your company to receive information and notices from REGFORM?