2026-2027 Sustaining Government Dues Form

In an attempt to keep our members' information up to date, we ask all of our Sustaining Government Members to help us by filling out this form to make sure we are billing you correctly. For any questions, please reach out to R'Mani White in membership at amca@mosquito.org.

Fields marked with an * are required.

District Name *

District Website *

District Manager Name (First & Last) *

District Manager Email Address *

Billing Contact (If same as district manager, fill with N/A) *

Billing Contact Email Address (If same as district manager, fill with N/A) *

Which staff member would you like to receive the vote from your membership? *

District Address *

Annual Budget *

Used to calculate Sustaining Government Dues.

Staff Information

AMCA's Sustaining Government Membership covers full membership benefits for all employees (minus a vote in the election).

Please attach a list (excel preferred) of your district employees that you want to be included in your Sustaining Government Membership. Need: First and Last Name, Email, and Professional Title

If you have employees who wish to also have a vote in the annual AMCA election, then they will need to continue to pay for a Regular Membership.

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