106 Main Street, Brookneal, VA 24528

866-376-7770  FAX 866-376-1156

APPLICATION FOR ASSOCIATE MEMBERSHIP

Please complete information in type or print.  Forward the application along with a check for $200 or complete the credit card payment information below.  Also send two letters of recommendation from current members of GMOA and signed Code of Ethics.  Mail to the above address.

As a supplier and/or vender to the bus industry, we/I hereby apply for active Associate Membership in the Georgia Motorcoach Operators Association. 
By signature I certify that I have been engaged in a business which supplies products or services of interest to operator members of GMOA for at least one year and that I do not own a motorcoach.

Company Name:  _________________________________________

Mailing Address:   _______________________________________

City:  ____________________  State:  _____  ZIP:  ___________

Telephone:  _________________  FAX:  ____________________

Email:  _____________________ Web:  _______________________

Category for Directory Listing: (Check the category that best describes your business and write cross reference (CR) next to any other category that describes your business.) 

___Attraction   ___Hotel   ___Restaurant   ___Sales, Service, & Products  

___Theatre   ___Tour Receptive   ___Tourism Agency 

List representative(s) who are to be listed as company contact(s) in the Directory and will be active in the Georgia Motorcoach Operators Association.*

Name                                                        Title

_____________________________  ___________________________

_____________________________  ____________________________

_____________________________  ____________________________

List key representative and correct mailing address for the individual who should receive all GMOA correspondence:

Key representative:  ________________________________________

Mailing address:  __________________________________________

City:  ______________________  State:  _____  ZIP:  ____________

Telephone:  __________________ FAX:  ________________________

Annual Membership Fee:  $200

Membership benefits include Associate Member’s admittance to a “deluxe vendors’ hospitality suite” and Market Place sessions during the GMOA Annual Meeting and one listing* in the GMOA Membership Directory that is distributed to all members.  Annual Meeting registration materials are sent to members only.

Information for Payment by Credit Card

Type: Visa ___  Master Card ___  American Express ___  Amount: $200

Card Number:  _________________________________________ 

Expiration:  ________________  Name On Card: _________________

Signature:  _________________________  Date:  ______________
                   (Applicant Representative)

Additional listings (for other locations, etc.) may be included in the directory at a cost of $50 per listing.

  GMOA FEDERAL I.D. NUMBER: 26-0033159