To apply for membership, print and complete the form below, then return to the Virginia Transit Association.
Membership Application
_____ Member -- Public Transit Systems (call the VTA office for
dues amount)
_____ Business Member ($1000)
_____ Associate Member Human Service Operator ($500)
_____ Associate Member Other; Organization ($100)
_____ Associate Member Other; Individual ($50)
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| Organization Name: | ________________________________________________________________ | |
| Principal Representative: | ________________________________________________________________ | |
| Title of Representative: | ________________________________________________________________ | |
| Mailing Address: | ________________________________________________________________ | |
| ________________________________________________________________ | ||
| E-mail Address: | ________________________________________________________________ | |
| Organization Web Site: | ________________________________________________________________ | |
| Telephone: | ____________________________ | |
| FAX: | ____________________________ | |
| Brief Description of Organization: | ________________________________________________________________ | |
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| ___________________________________________________ | ____________________________ | |
| Signature of Applicant | Date | |
Return to:
Virginia Transit Association
1108 East Main Street, Suite 1108
Richmond, Virginia 23219