Associate Membership Application

Thank you for your interest in applying for associate membership with the Alaska Telecom Association. Please complete the form below. Your application will be presented to the ATA Board of Directors at the next scheduled meeting.

Upon acceptance by the Board, you will receive a letter so stating and your company will be listed in the membership directory. You will be placed on our mailing list to receive all memos and materials’ pertaining to ATA’s many activities throughout the year. You will also receive discounted rates when you attend any of our conferences or trade show.

If you have any questions or comments, please do not hesitate to contact our membership director at (907) 563-4000.

Thank you again and we look forward to welcoming you as a new member!

Organization Information

Organization Name

Website

http://

Organization Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Main Phone

(###)

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Main Fax

(###)

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Primary Contact Information

Primary Contact Name

First Name

Last Name

Primary Contact Title

Primary Contact Email

Primary Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Contact Phone

(###)

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Billing Contact Information

Billing Contact Name

First Name

Last Name

Billing Contact Title

Billing Contact Email

Billing Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Billing Contact Phone

(###)

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Additional Information

Business Description

Please enter a short description about your business. Please be product/service specific.

Additional Key Personnel

List any additional key personnel to add to this membership, formatting as follows: [Name, Position/Title, Email, Contact Phone Number], with each contact on a new line.

Contributions or gifts to the Alaska Telecom Association are not deductible as charitable contributions for federal income purposes. However, dues payments may be deductible by members as an ordinary and necessary business expense.