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Please allow 24-48 hours for your application to be processed and approved. If you have any questions, please contact [email protected] - UStiA Member Services

Organization Information (to be displayed online)

Organization Name *

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Fax

Website

Email *

Main Contact

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Title

Phone *

Email *

Billing Address (if different)

Street

City

State

Zip

Mailing Address (if different)

Street

City

State

Zip

Additional Information

Referred by

How did you hear about us?

What is your reason for joining?

Please have someone contact me regarding

*Check all that apply
Business Resources
Community Involvement
Cost Savings Programs (Insurance, Office Supplies, Worker's Compensation)
Economic Development
Government Relations
Networking

Other

Membership Investment

Membership Type: *

Primary Directory Category *

Additional Directory Categories

**Hold CTRL on your keyboard to select multiple categories**

Additional Contacts

You are allowed up to 0 contact(s) for free. Each additional contact costs $250

Annual Membership Investment

Total: $

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost

Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)

tempValueForDropDown1

Revenue Item Number

Number of Full Time Employees:
Number of Part Time Employees:
Number of Rooms (Accommodations):
Number of Seats (Restaurants):
Number of Associates (Realtors, Attorneys):
Number of Locations ($35/add. location):
Millions in Assets (Financial Institutions):
Enhanced Membership ($50):
Additional Categories Cost	$
One-Time Application Fee	$
Tax	$
Payment Type *
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

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