Transfer Membership Form

This form allows companies to transfer a membership from one individual to another. It is a two-step process. The first step requires you to fill out the form below which provides information about the person who currently holds the membership. The second step requires you to fill out a form providing information about the person who will receive the membership. The second form will appear after you have complete the first form and hit the continue button below. Please be sure to fill in all the information on this form before continuing. Note: All transfers must be reviewed and approved by SMPS before they can take effect.

Please provide the following information about the person who currently holds the membership:
Prefix:
First Name:
Middle Name:
Last Name:
Is this person still employed with the company?
	Yes No
Address Line 1:
Address Line 2:
City:
State or Province:
Zip Code:
Country:
Work Phone Number:
Fax Number:
E-Mail Address:
Provide the name of the person authorized by the firm to effect this transfer:
Authorized Person:
Date of Authorization:
Please review this form carefully. Make sure all information is provided. Incomplete forms will not be processed. Print this form for your records BEFORE continuing on.