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Corporate Membership Agreement
University Membership Agreement
Government Affiliate Agreement
Individual Affiliate Agreement

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ISTPA Government Affiliate Enrollment

Fill out Government Affiliate Enrollment Form and Government Affiliate Agreement.

Print and sign Government Affiliate Enrollment Form and Government Affiliate Agreement. Send signed Government Affiliate Enrollment Form and Government Affiliate Agreement to:

Upon application approval your firm will be invoiced (prorated) for the applicable 1st year affiliate dues and upon payment you will be notified by email that your affiliate user account has been activated. This email notification will provide instructions to access your online affiliate account. Please allow for 2-3 weeks for processing of the affiliate enrollment requests.

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

Fill out government affiliate enrollment form.

* REQUIRED FIELDS

* Government Name:

Office/Department/Agency Name:

* Address 1:

Address 2:

* City:

* State/Province:

* Zip or Postal Code:

* Country:

* Main Phone:

Ext:

Main Fax:

URL:

Year Your Office/Department/Agency Established:

Annual government affiliate dues:

Government Affiliate

The annual government affiliate dues are $1,000 USD per year.

$1000 USD per year

Affiliate Primary/Administrative Contact

* First Name:

* Last Name:

Title:

* Phone:

Ext:

Fax:

* Email:

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

* Username:

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

* Password:

* Retype Password:

* Affiliate 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 government representative(s) that will be included in the ISTPA directory

First Name:

Last Name:

Phone:

Email:

First Name:

Last Name:

Phone:

Email:

First Name:

Last Name:

Phone:

Email:

For adding additional representatives contact the ISTPA Executive Director.

Print, sign and send Government Affiliate Enrollment Form and Government Affiliate Agreement.

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

Send signed Government Affiliate Enrollment Form and Government Affiliate Agreement to:

Upon application approval you will be sent, by US Mail, an ISTPA counter signed agreement with an invoice, (prorated) for the applicable 1st year affiliate dues. Upon payment you will be sent an email notification with instructions to access your online affiliate account. Please allow for 2-3 weeks for processing of the affiliate enrollment requests.

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

John Sabo
President
(703) 708-3037

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

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