MAPI -- Become A Member | Membership Form

Please fill out this membership form.

Before purchasing or renewing a membership, you must fill out this form so that we can make sure our records are correct and up to date. After the form has been submitted, you will be shown the link to order the membership via PayPal. Thank you.

License Holder Name:

MN License Number:

Company Name:

Business Address: (please include street address, city, state, and ZIP)

Phone Number:

Email Address:

Company Website Address:

Other State(s) PI/PA License #s

FOR ASSOCIATES: Employee/Vendor Name/Out of State PI Name

MAPI Membership Form

Please fill out this membership form.