Become A Member Membership Type(Required) MISA Business Membership MISA Individual Membership MISA Business MembershipBusinesses can purchase a membership for $50 per year to help support the Michiana Institute for Successful Aging. Membership privileges include: Use the MISA network via social mediums to promote your organization Your link on our member directory Access to experts who can provide education and training opportunities Relationship, leadership, and skill building opportunities by serving on MISA committees Alternative approaches to issues that matter MISA Business Membership Price: MISA Individual MembershipIndividuals can purchase a membership for $25 per year to help support the Michiana Institute for Successful Aging. Membership privileges include: Use the MISA network via social mediums to promote your organization Your link on our member directory Access to experts who can provide education and training opportunities Relationship, leadership, and skill building opportunities by serving on MISA committees Alternative approaches to issues that matter MISA Individual Membership Price: Contact InformationName(Required) First Last Organization Phone(Required)Email(Required) Subscribe to the MISA Email Newsletter Yes! MISA may send me an email newsletter. Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Payment InformationPayment Total Membership Renewal AnnualBilling Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card(Required)Feed Required: To use the Stripe field, please create a Stripe feed for this form.
