VIRGINIA MOTORCOACH ASSOCIATION                                                                                                                            Back to Membership Page
106 Main St., Brookneal, VA 24528
434-376-1150 FAX 434-376-1156

APPLICATION FOR OPERATOR/ TOUR OPERATOR MEMBERSHIP AND DIRECTORY INFORMATION
Company Name:    ________________________________________________________  

Mailing Address:    ________________________________________________________

City:   _____________________________    State: _____    ZIP:  ____________________  

Telephone(list all extensions desired in the directory):    ______________________ 

Toll Free:   _______________________     FAX:    ________________________ 

Email:   _____________________________      Web:   _________________________________
Mailing Address, if different from address above:

________________________________________________________________________                  

List key personnel to be included in the directory:
NAME                                                         TITLE                                               HOME TELEPHONE

________________________             ___________________             ____________________

________________________             ___________________             ____________________

________________________             ___________________             ____________________

________________________             ___________________             ____________________

Check the items listed below that apply to your company:

Check the items listed below that apply to your company:
A   ___   Regular Route Carrier                               E   ___  Own and Operate Maintenance Facilities
B   ___   Charter Coach Operator                           F    ___  Intrastate (VA) Operators Only
C   ___   Package Tour Operator                           G   ___  Intrastate and Interstate Operations
D   ___   Bus Express Carrier

Date started business  __________         Number of coaches operated  ____          Periodic mailings to (number) _______ customers.

Membership Dues Amount:
No Buses (Tour Operator): $50                    1-10 Buses: $100                    11 or more Buses: $200

Requirements for Membership:
1. Completed Application Form
2. Payment (Check or Credit Card)
3. Two Letters of Recommendation from Current Operator Members
4. Signed Code of Ethics
5. Proof of insurance and the certificate of insurance must be sent to the VMA office initially and annually with the renewal.
6. Copy of Operating Authority (State and Federal)
7. Affirmative Vote by the VMA Board of Directors
Information for Payment by Credit Card:
Type:  Visa____        Master Card____         American Express____           Amount: $______ 
Card Number: _________________________________________  
Expiration:  ________________________   Name on Card:  ___________________________  
Signature:  _______________________________________      Date: ______________
                        (Applicant Representative)

VMA FEDERAL I.D. NUMBER: 54-1147461  
Note: 85% of your VMA dues may be used as a tax deduction.