MiBAP Membership Payment

ONE YEAR MEMBERSHIP PAYMENT FORM

One Year Membership Payment Form

Facility Name(Required)

Primary Contact Name(Required)

First Last

Primary Contact Professional Title(Required)

MiBAP membership dues are determined based on annual ABA services revenue in the state of Michigan. Dues cover membership for a one-year period.

Select a Membership Tier(Required)

Active Member - NEW: In business for less than 18 mo's. | $1,000/YR Dues

Active Member - TIER 1: Less than $1M Annual ABA Services Revenue in MI | $2,000/YR Dues

Active Member - TIER 2 $1M - $3M Annual ABA Services Revenue in MI | $3,000/YR Dues

Active Member - TIER 3 $3M - $5M Annual ABA Services Revenue in MI | $4,000/YR Dues

Active Member - TIER 4 Over $5M Annual ABA Services Revenue in MI | $6,000/YR Dues

Affiliate Member $500/YR Dues

Individual Affiliate Member $250/YR Dues

Total

Payment Method(Required)

AUTO-RENEW MEMBERSHIP PAYMENT FORM