Membership Application

Directions: Select the type of membership, complete the rest of the form, and then click the [SUBMIT] button.

Region ...

  click here to find your region
                                (if you serve more than one region, select the one with the majority of your service area)

Joining as ...

Organization  Associate  Individual (click here to go to the individual section)

Organization/Associate Member Application (May 1 - April 30) - $100 for Organizations/$200 for Associates

Organization

Affiliation Type   

Website

include http://

Address

 

City

Phone

Fax

Contact Name

First Middle Last Last

Contact Email Address

Is this organization a member of your local chamber of commerce?      Yes  No

CLICK HERE SKIP TO PAYMENT SECTION

Individual Member Application (May 1 - April 30)

Is your leadership organization a member of ATLP?      Yes - I will pay $10    No - I will pay $25

Would you like to be a lifetime member?                 

Member Name

First Middle Last

Organization

 

Affiliation Type   

Website

 include http://

Address

 

City

Phone

Fax

Email Address

Payment

Total Amount Due: $

I will pay by:           Check  Credit Card
Test: enter this information in the field provided. If you do not, you will receive an error message.