Join the Virginia Transit Association

 

VTA Membership Application

To apply for membership, print and complete this form, then mail to the address below.

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; Individual ($50)
_____ Associate Member – Other; Organization ($100)

Organization Name: _______________________________________________________

Name of Principal Representative: ____________________________________________

Title of Representative: _____________________________________________________

Mailing Address: _________________________________________________________

_______________________________________________________________________

E-mail Address: _________________________________________________________

Organization Web Site: ___________________________________________________

Telephone: ( ____ ) _____________________ FAX: ( ____ ) _____________________

Brief Description of Organization: ___________________________________________

_______________________________________________________________________

_______________________________________________________________________


_________________________________________   __________________________

(Signature of person making application)               (Date)

Return to: Virginia Transit Association
1108 East Main Street, Suite 1108
Richmond, Virginia 23219