Membership Application

ORGANIZATION INFORMATION

Organization name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone number*

Point of contact name*

First Last

Point of contact title*

Point of contact email*

ORGANIZATION'S BUSINESS*

Select NO MORE THAN TWO of the following categories to describe your organization:

Other (please specify):

NAME/URL OF WEB SITE(S)

You may list up to a total of six sites on the Member B2B Directory posted on the TAtech site:

Name	URL

NAMES OF NEWSLETTER SUBSCRIBERS

You may subscribe an unlimited number of employees to the TATECH Member Newsletter. The more you list, the better informed your organization will be about TATECH activities and opportunities. Please provide both the name and email address for each employee you subscribe. Attach a separate sheet of paper, if necessary, to list your names.

Name	Email

ANNUAL DUES

Annual dues are based on the organization’s self-reported revenues for the previous year. Dues payments by individual Member organizations are kept strictly confidential. Use the drop down window to select the appropriate dues level for your organization.

SITE(S) REVENUE*

Total Due

$0.00