Any individual who is not employed by an organization eligible for Private Entity Membership may apply for Individual Membership. FY20 Individual Membership Form Individual InformationName:* First Last Are you a current member of any of the following membership organizations?Check all that apply ABH ADDP maaps MNN The Provider's Council Other None Contact InformationPreferred Phone Number:*Email:*Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code CLM BenefitsIf you would like an overview of CLM's membership benefits before completing this renewal form, please visit our website. Otherwise a copy of the membership benefits will be sent to you upon completion of your membership application.Membership DuesCLM dues for individuals is $133 for FY20. Dues Agreements* Select All I understand that I will be billed on or shortly after July 1st I understand that if I fail to pay by September 30th, I will no longer be considered a CLM member and removed from CLM's rosters and benefits