Application for Membership- American Teleservices Association

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Refer a Member

Please use the form below to renew your membership online with a credit card. If you have any questions, or need to request a copy of your invoice or a copy of the ATA Member logo, please call our office directly at (317) 816-9336.

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:

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 attest that I have read and will comply with the ATA Code of Ethics 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