| VIRGINIA MOTORCOACH ASSOCIATION 106 Main St., Brookneal, VA 24528 434-376-1150 FAX 434-376-1156 APPLICATION FOR ASSOCIATE MEMBERSHIP Please complete information in type or print. Forward the application along with a check in the amount of $200 made payable to VMA. Mail to the above address. As a supplier and/or vendor to the bus industry, we/I hereby apply for active Supplier Membership in the Virginia Motorcoach Association. By signature I certify that I am engaged in a business which supplies products or services of interest to operator members of VMA and that I do not own a motorcoach. Company Name: ________________________________________________________ Mailing Address: ________________________________________________________ City: _____________________________ State: _____ ZIP: ____________________ Telephone: ______________________ FAX: ________________________ 800 #: _______________________ Email: _______________________ Web: __________________________ A description (20 words or less) of your company to be added to your listing in the membership directory: __________________________________________________________________________________ __________________________________________________________________________________ Category for Directory Listing: (Check the category that best describes your business and write cross reference (CR) next to any other category that describes your business.) ___Sales, Service & Products ___Tour Receptive List representative(s) who are to be listed as company contact(s) in the Directory and will be active in the Virginia Motorcoach Association. ______ List key representative and correct mailing address for the individual who should receive all VMA correspondence: Key representative: ________________________________________________________ Mailing address: ________________________________________________________ City: _____________________________ State: _____ ZIP ____________________ Telephone: _______________________ FAX: __________________________ 800 #: ____________________ Annual Membership Fee: $200 Membership benefits include the VMA Annual Meeting and one listing in the VMA Membership Directory that is distributed to all members. Annual Meeting registration materials are sent to members only. Type: Visa____ Master Card____ American Express____ Amount: $200 Card Number: _________________________________________ Expiration: ________________________ Name on Card: ___________________________ Signature: _______________________________________ Date: ______________ (Applicant Representative) VMA FEDERAL I.D. NUMBER: 54-1147461 Note: $128 of your VMA dues may be used as a tax deduction. |