Membership Application

Please fill out all appropriate fields so we can serve you better. Required fields are in red.

Company Name:
Is company a registered non-profit organization?
Total number of employees at all worksites:
Primary Contact (for mailings, meeting information, etc.):
Name:		Position/Title:
Telephone:	Fax:		E-mail:
Mailing Address:
City:	State:		Zip:
Billing Address: (if different from above)
City:	State:		Zip:
Additional Contact Name:
1) Name:		Position/Title
Telephone:	Fax:		E-mail:
Mailing Address:
City:	State:		Zip:
Additional Contact Name:
2) Name:		Position/Title
Telephone:	Fax:		E-mail:
Mailing Address:
City:	State:		Zip:

Please note: Membership dues are based on total number of employees at worksite(s):

Total # employees x $1.50/employee = Annual Dues ($250.00 minumum contribution); or $1.00/employee for non-profit organizations.
Membership dues will be prorated by quarter for registration after July 1st of the fiscal year

Additional Worksite Locations Included:

Note: Press Preview below to check your request. You will get another chance to make changes, send it, or cancel your request. You will also be given an estimate of your annual dues. An invoice will be generated for your dues after we process your application.

The IRS has ruled that the TMA Delaware is exempt from taxes under section 501(c)(04) of the Internal Revenue Code. It is not considered charitable however, and contributions and membership fees are not deductible as charitable contributions for Federal Income Tax purposes.

Last program update: 03 January 2002
Program Maintained by: Ken Weaverling