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Membership Application

Note: Membership dues are assessed annually in accordance with the categories noted below: Please check your membership preference and submit ONE APPLICATION PER MEMBER; duplicate as necessary.

____ (A) Corporate -$200 Entitles member to four employee designates on the GTEDC, with the option to add additional members at the rate of $50 per member.

____ (B) Business -$75 Entitles member to one employee designate on the GTEDC, with the option to add additional members at the rate of $50 per member.

____ (C) Educational, Non-Profit, Association -$75 Entitles member to one employee designate on the GTEDC, with the option to add additional members at the rate of $50 per member.

____ (D) Individual -$50

Name/Title: ___________________________________________________

Company Name/Address/Zip: _______________________________

Telephone: (____) _______________ FAX: (____) _____________

E-Mail: _____________________ Website: _________________

For Member Categories (A) (B) & (C), list the names of all designated members:

_________________________________________________________

_________________________________________________________

Method of Payment (check one):

___ Check Enclosed/Amount: $___________________________

___ Please check to request an invoice be sent to your attention

Please return application and payment to:

Deborah Lewis

GTEDC

SAU, P. O. Box 9135

Magnolia, AR 71754-9135

Ph: 870-235-4924

Fax: 870-235-5110