2024 Associate Member Dues

Company

Company Name

Address Line 1

Address Line 2

City

State

Postal Code

Phone Number

Alternate Phone #

FAX #

Company email

Company website address

First Name

Last Name

Email Address

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Phone Number

Mofairs events served

Primary service / products

Payment Options Online orders will add a 4% fee

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I'll pay by credit card now

I'll send a check

If paying by check...

• this form is still required
• mail your check for $65 to:

MoFairs
10075 Bust Subdivision Rd.
Potosi, Missouri
63664

• bypass the 'credit card' section below

Credit Card

Associate Membership

$65.00

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