Georgia Motorcoach Operators Association                                                                                                                 Back to Membership Applications
106 Main Street, Brookneal, VA 24528
866-376-7770              FAX 866-376-1156
 
Membership Application and Directory Information
 
Name of Company:  __________________________________________________
 
Address:  __________________________________________________
 
City:   _____________________________   State: _____ ZIP: ____________________
 
Telephone (list all extensions desired in the directory):

_____-_____-_______         _____-_____-_______          FAX:   _____-_____-_______        

Email: ____________________________________          Web: _____________________                

Mailing Address, if different from address above:
________________________________________________________________________       


List key personnel to be included in the directory:
NAME                                                TITLE                         HOME TELEPHONE

________________________      ___________________     ____________________
 
________________________      ___________________     ____________________
 
________________________      ___________________     ____________________
 
________________________      ___________________     ____________________
 
Check the items listed below that apply to your company:
A   ___   Regular Route Carrier                               E   ___  Own and Operate Maintenance Facilities
B   ___   Charter Coach Operator                            F    ___  Intrastate (GA) Operators Only
C   ___   Package Tour Operator                             G   ___  Intrastate and Interstate Operations
D   ___   Bus Express Carrier

Date started business  __________

Number of coaches operated  ____      Periodic mailings to (number) _______ customers.

Information for Payment by Credit Card:

Type:  Visa ____    Master Card ____    American Express ____                 Amount: $250

Card Number:  _________________________________________           

Expiration:  _____________________         Name On Card: ___________________________

Signature:  ____________________________________    Date:  _______________________
 

Requirements for membership:
1.        Completed Application Form
2.        Payment in the Amount of $250 (Check or Credit Card)
3.        Two Letters of Recommendation from Current Operator Members
4.        Signed Code of Ethics
5.        Proof of Insurance (copy of insurance certificate)
6.        Copy of Operating Authority
7.        Affirmative Vote by the GMOA Board of Directors   
 
GMOA FEDERAL I.D. NUMBER: 26-0033159