NIRSA Mailing List Request Form
You must complete all fields of this form in order to have your application processed.
NIRSA Mailing List Usage Policy
NIRSA Associate members and non-members may purchase NIRSA’s membership lists on a one-time-use only basis. Materials cannot specifically reference any affiliation or connection with NIRSA without receiving express written permission from NIRSA. Orders cannot be finalized without the submission and approval of proposed mailing material. NIRSA does not sell email addresses. Please email with questions.
1) Complete the NIRSA Mailing Address Request Form. All fields in this form must be completed in order to have the application processed.

2) Submit an electronic sample (flyer, announcement, etc.) of the mailing to NIRSA must approve all materials being sent prior to the mailing list being fulfilled.

3) Invoice is sent for project approval.

4) Submit complete payment. NIRSA accepts VISA, Discover, MasterCard, and American Express, and checks.

5) Mailing list requests will be fulfilled 3 business days after receipt of payment. One time use lists are delivered electronically in Excel format.
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Email address: *
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Daytime Phone:
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Target Audience:
Member Type: *
Location (States, Regions, Universities, etc): *
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Functional Titles Requested: *
Job Responsibilities Requested: *
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