UPDATE MEMBER INFORMATION

MEMBERSHIP APPLICATION

NMFSA Update Member Information Form

Dear NMFSA Members,

Please provide the New Mexico Funeral Service Association with the most updated information for our records by completing the form below.

Please Choose A Membership Type:

Individual

Vendor

Firm

Member Name:

Date of Birth:

Funeral Directors License Number:

Date Licensed in PA:

Funeral Home Name:

Funeral Home Address:

City:

State:

Zip Code:

Address at Which You Prefer to Receive Mail:

Phone:

Email:

Local Association:

Free Text

If Firm membership, please list all employees' name, date of birth and license numbers below:

Name:

Date of Birth:

License Number:

Name:

Date of Birth:

License Number:

Name:

Date of Birth:

License Number:

Additional Employees: