Membership Application

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Membership Application
Visit our website and join online:
PART I - COMPANY INFORMATION
Company Name: ____________________________________________________________________________________________
Street Address: ______________________________________________________________________________________________
City: __________________________ State/Province: _____________ ZIP/Postal Code: __________ Country: _______________
Phone: ( ____ ) ____________________ Fax: ( ____ ) ____________________ Website: _________________________________
Occasionally, BTA makes its member list available to companies that wish to present opportunities to our members.
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Can BTA include your e-mail address in the online BTA Membership Directory?
Yes
No
No. of locations
: __________ No. of employees (include owners): __________
(include parent)
Year business was established: __________ Annual revenue: $ __________
Contact Names:
Principal Contact: __________________________________ Title: ____________________ E-mail: __________________________
Sales Contact: _____________________________________ Title: ____________________ E-mail: __________________________
Service Contact: ___________________________________ Title: ____________________ E-mail: __________________________
Heard about BTA from/Referred by (name & company): ___________________________________________________________
Suppliers and vendors to BTA members may communicate with member dealers, indicating membership in and support of the association. Suppliers and
vendors are prohibited from indicating or suggesting that BTA approves, supports, endorses or encourages its members to use the products or services be-
ing promoted or endorses the supplier or vendor of the product.
PART II - MEMBERSHIP CATEGORIES & CLASSIFICATIONS
Retail Dealer Memberships
Vendor Associate Memberships
Service Associate Memberships
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One Year: $430
$1,500 -
$500 -
Annual sales up to $5 million
Annual sales up to $1 million
(You receive $400 in coupons.)
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$2,000 -
$750 -
Annual sales $5-10 million
Annual sales $1-5 million
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Two Years: $795
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$2,500 -
$950 -
Annual sales over $10 million
Annual sales over $5 million
(You receive $950 in coupons.)
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$150
Publications Associate Membership:
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PART III - INVESTMENT
Select one:
Payment Enclosed
(Make check payable to Business Technology Association)
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MasterCard
Visa
American Express
Annual BTA Dues: $__________
Card Number: __________________________________________ Exp. Date: ________________ Security Code: ____________
(Three-digit code on back;
I hearby apply for membership in Business Technology Association:
AmEx: 4-digit code on front)
Card Holder’s Name: _________________________________________ Email Address: __________________________________
Signature: _________________________________________________________________ Date: ___________________________
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Same as above or
See below (please fill in billing information):
Billing Address:
Company Name: ____________________________________________________________________________________________
Street Address: ______________________________________________________________________________________________
City: __________________________ State/Province: _____________ ZIP/Postal Code: __________ Country: _______________
Phone: ( ____ ) ____________________
Return to: Business Technology Association, 12411 Wornall Road, Kansas City, MO 64145
Phone: (800) 505-2821 • Fax: (816) 303-4056 • E-mail: • Join online at
Membership dues must be submitted in U.S. funds. Dues paid to BTA do not qualify as a charitable tax deduction. Dues do qualify as a business expense.

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