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ISTPA Corporate Membership Enrollment

Fill out Corporate Membership Enrollment Form and Membership Agreement.

Print and sign Corporate Membership Enrollment Form and Membership Agreement. Send signed Corporate Membership Enrollment Form and Membership Agreement to:

Upon application approval your firm will be invoiced (prorated) for the applicable 1st year membership dues and upon payment 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 corporate 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 select the annual membership dues category:

Level 1	Sponsor	$4000 USD per year
Level 2	Member	$1000 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 representatives contact the ISTPA Executive Director.

Print, sign and send Corporate Membership Enrollment Form and Membership Agreement.

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

Send signed Corporate Membership Enrollment Form and Membership Agreement to:

Upon application approval your firm will be sent, by US Mail, an ISTPA counter signed agreement with an invoice, (prorated) for the applicable 1st year membership dues. Upon payment you will be sent an email notification with 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
(703) 708-3037

Kevin O'Neil
Executive Director
(858) 793-8100

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