Application for Membership- American Teleservices Association

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Refer a Member

If you prefer to pay by check or offline, you can download the application form here. If paying by check, please print the application form and mail with your payment. Please note that no membership applications are accepted without payment.

To RENEW your ATA membership, click here.

Contact our office directly at (317) 816-9336 for your copy of the ATA Member Logo.

Membership Category

	Platinum Membership* $5,000 (Benefits)	Small Business Membership $695

	Corporate Membership* $2,895	Non-profit Membership $195 (Requirement)

	Corporate Membership* $1,795	Academic Membership $150 (Requirement)

*Corporate Members please list affiliates on the form that will be provided immediately after you submit this application.


Primary Contact Information
ATA Member Companies, unless otherwise indicated, are entitled to One Vote in the matters requiring a vote of the Members. The Primary Contact listed below will be the person to whom ATA will send any ballots and Membership Dues Invoices. Corporate Members may enroll as many Affiliate Members (employees of the same company) as they choose. A separate form is included for enrolling Affiliate Members.

Salutation:
First Name:
Last Name:
Job Title:

Company:

Company Type:

Address:

City:
State:
ZIP/Mail Code:
Country:

Telephone:
Fax:
E-mail:
Website Address:
Additional Locations:
Specialties 1:	Press and hold Ctrl to select multiple options
Brief Company Description: (25 Words or Less)

If you would like to become a member of a local chapter of the ATA, please select it from the list. Chapter membership is free to all ATA Members:

Questionnaire

Has your company been a member of ATA in the past?
		Yes	No

Have you been a member of ATA in the past?
		Yes	No

How did you first hear about the ATA?


What prompted you to join?


I am interested in the following committees. Please have someone contact me.

Additional Comments

Payment

Credit Card:
Card Number:
Name on Card:
Expiration Date:

By clicking the submit button: I attest that we are eligible for the Membership category chosen. I agree to authorize the above total Membership fee according to the card issuer agreement.

American Teleservices Association
3815 River Crossing Parkway, Suite 20
Indianapolis, IN 46240
317.816.9336 ● www.ataconnect.org

Platinum Membership* $5,000 (Benefits)

Platinum Membership*
$5,000 (Benefits)