Promotional Products Association of the Mid-South

Prefix

Clear selection

Mr

Ms

Mrs

Mx

Dr

Title

*First Name

Middle Name / Initial

*Last Name

Suffix

Designation / Certification

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BASI

CAS

MAS

MAS+

MASI

TAS

Please select your promotional products industry designation/ certification.

*Company Name

Website

*Email

*Office Phone

Office Phone Extension

Mobile Phone

Fax

*Address

*City

*State Code

*Zip

Country

Shipping / Mailing Address (if different from above)

Shipping / Mailing City

Shipping / Mailing State Code

Shipping / Mailing Zip

*Business Type

ASI#

PPAI#

SAGE#

UPIC#

*Amount ($USD)

Payment frequency

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Monthly

Quarterly

Semi-annually

Annually

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