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Membership Enrollment [pdf]

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ISTPA Membership Enrollment

Fill out membership enrollment form.

Print and sign enrollment form. Make 1st annual membership dues check out to ISTPA. Send signed enrollment form and company check to:

Upon approval and clearance of funds you will be notified by email that your membership has been activated. This email notification will provide instructions to access your online membership account. Please allow for 2-3 weeks for processing of the membership enrollment requests.

If for any reason your application for membership is declined you will be contacted and if unresolved your check will be returned promptly.

Fill out membership enrollment form.

* REQUIRED FIELDS

* Company Name:

Division/Group Name:

* Address 1:

Address 2:

* City:

* State/Province:

* Zip or Postal Code:

* Country:

* Main Phone:

Ext:

Main Fax:

URL:

Year Your Company Established:

Public/Private:

Public

Private

Is this company a subsidiary of another?

Yes

If subsidiary, Name of Parent Company:

Please check the annual membership dues category for which you qualify:

Level 1	Annual revenue equal to or in excess of $100 million	$8000 USD per year
Level 2	Annual revenue equal to or in excess of $10 million but less than $100 million	$4000 USD per year
Level 3	Annual revenue equal to or in excess of $1 million but less than $10 million	$1000 USD per year
Level 4	Annual revenue less than $1 million	$250 USD per year

Membership Primary/Administrative Contact

* First Name:

* Last Name:

Title:

* Phone:

Ext:

Fax:

* Email:

Membership Account Username
(select a username 6-20 alpha numeric characters A-Z, a-z, 0-9 no special characters allowed)

* Username:

Membership Account Password
(select a password 6-12 alpha numeric characters A-Z, a-z, 0-9 no special characters allowed)

* Password:

* Retype Password:

* Membership Billing Contact

Same as above

First Name:

Last Name:

Title:

Phone:

Ext:

Fax:

Email:

Billing Address

Company Name:

* Address 1:

Address 2:

* City:

* State/Province:

* Zip or Postal Code:

* Country:

Additional company representative(s) that will be included in the ISTPA membership directory

First Name:

Last Name:

Phone:

Email:

First Name:

Last Name:

Phone:

Email:

First Name:

Last Name:

Phone:

Email:

For adding additional company contact the ISTPA membership administrator.

Print, sign and send membership enrollment form

ISTPA
By:	_________________________________	By:	_________________________________
ISTPA Officer		Title:	_________________________________
Date:	_________________________________	Date:	_________________________________

Send signed membership agreement and company check (made payable to ISTPA) to:

Following membership approval, an email notification will be sent with an ISPTA counter signed agreement sent US Mail. This email notification will provide instructions to access your online membership account. Please allow for 2-3 weeks for processing of the membership enrollment requests.

If any issues arise with regard to membership enrollment or payment of dues you will be contacted by the ISTPA. If you have any questions regarding membership enrollment or the ISTPA please contact:

John Sabo
President
(410) 974-0016

Sarah Lindquist
Manager, Member Services and Administration
(703) 478-7600

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