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

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ISTPA Individual Affiliate Enrollment

Fill out Individual Affiliate Enrollment Form and Individual Affiliate Agreement.

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

Upon application approval you 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 individual affiliate enrollment form.

* REQUIRED FIELDS

* Affiliate First Name:

* Last Name:

* Affiliate Name:

* Address 1:

Address 2:

* City:

* State/Province:

* Zip or Postal Code:

* Country:

* Phone:

Ext:

Fax:

* Email:

URL:

Annual individual affiliate dues:

Individual Affiliate

The annual individual affiliate dues are $250 USD per year.

$250 USD per year

Affiliate Primary Representative:

* 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

Name:

* Address 1:

Address 2:

* City:

* State/Province:

* Zip or Postal Code:

* Country:

Individual affiliate legal representative (optional). Note: Individual affiliates may designate an attorney or legal representative who has power of attorney regarding ISTPA matters.

First Name:

Last Name:

Phone:

Email:

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

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

Send signed Individual Affiliate Enrollment Form and Individual 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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