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NEMRA “Just 1” Member Referral Form
Know a company that should be part of NEMRA? Submit a referral below. Our team will handle the outreach.
*
1.
Your Information
(Required.)
Your Name (First & Last)
Company Name
Email Address
Phone Number
*
2.
Referral Information
(Required.)
Referral Company Name
Primary Contact Name
Contact Title
Email Address
Phone Number
*
3.
Company Type
(Required.)
Manufacturer
Representative Agency
Other
*
4.
Company's Primary Market/Focus
(Required.)
*
5.
Company's Location (City, State)
(Required.)
*
6.
Are they familiar with NEMRA?
(Required.)
Yes
No
Not Sure
*
7.
Have you informed them you are making this referral?
(Required.)
Yes
No
*
8.
Can NEMRA mention your name when reaching out?
(Required.)
Yes
No
Thank you for your referral. A member of our team will connect with your referral shortly to begin the conversation.
