First Name: Middle Initial: Last Name:

BUSINESS INFORMATION

Company: Title:
Business Address
Business City:
Business State: AL AK AR AS AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NJ NM NY OH OK PA RI SC SD TN TX UT VA VT WA WV WY Business Zip:
Business Telephone:
Business Fax:
Business Email:

PERSONAL INFORMATION

Home Address:
Home City:
Home State: AL AK AR AS AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NJ NM NY OH OK PA RI SC SD TN TX UT VA VT WA WV WY Home Zip:
Home Phone:
Birthdate (MM/DD/YYYY):
Spouse's First Name:

TYPE OF MEMBERSHIP - All new memberships in 2007 pay prorated dues through June 30, 2008

Resident* ................................................................................ $90.00 / year - $7.50 / month
Non-Resident ......................................................................... $60.00 / year - $5.00 / month
Honorary (newsletter & mailing fee only) ................................ $18.00 / year - $1.50 / month
High School/ College Student**................................................ $18.00 / year - $1.50 / month
Unemployed/Government Employee Member ........................ $18.00 / year - $1.50 / month

ROSTER CATAGORY - Please Check One

Air Transport/Forwarder
Rail/Intermodal
Other Interests
Commercial Firm (Shipper)
Moving/Storage
Steamship Lines
Motor Carriers

PAYMENT

Method of Payment

Visa MasterCard I'll send my check by mail

Card Number (no spaces please)

Expiration Date

VCode (3 digit code on the back of card)

If you are expercing technological problems please download
the Word version here and fax to 303-841-3748