Member Enrollment Completion of this member enrollment form will register you an inactive account at nloma.org. Once we have processed your payment, reviewed your request and activated your account, you will receive notification by email. Personal InfoName* First Last Email* Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Camp Name or OrganizationPlease let us know the organization with which we should identify your NLOMA membership.Membership InfoAccount Username*This will be used as your login for the nloma.org website.Password*Please enter a strong password. You will be able to enable two-factor authentication once your account is created. Enter Password Confirm Password Strength indicator Membership Level*To what level of membership are you enrolling this year?Level ALevel BLevel CLevel DPayment DetailsMembership DuesYour payment of these registration dues will be securely processed through Stripe. $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.