Important Note: Members must be from the New England/New York area and able to attend meetings and participate in association activities. We cannot grant membership in name-only to applicants from distant areas who are not able to participate.

Name (first, middle, last):________________________________________________________

Professional Designation (i.e CSQA, PMI):_________________________________________

Which e-mail address should we use for your newsletters and flyers? Work___   or Home___   (U.S. Mail Only)  
Fill out either the work or home address below to match your choice above-asking where you prefer your QAAC communications be sent. You only need to list one e-mail address. Please be sure to notify the membership director if your e-mail address changes during the year *Note QAAC would prefer to use e-mail only for all membership communications.

Company or Employer Name:_____________________________________________________

·        Business Address:__________________________________________________________

Line 2: _______________________________________________________________________

City: __________________________________   State:____    Zip Code: ___________________

Work Phone:  ____________________________________

Work E-mail:_____________________________________________________________

·        Home Address: ____________________________________________________________

 City: __________________________________   State:____    Zip Code: ___________________

Home Phone:    _____________________________