NATIONAL ASSOCIATION OF TOBACCO OUTLETS
2009 Associate Membership Application
Form
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(Use this form
if your company is primarily engaged in the business of providing
services or non-tobacco related ancillary products to tobacco retail stores)
Company: ________________________________________________________________
City/State: ___________________________________________________
Zip __________
Telephone: ________________________________________________________________
Facsimile: _________________________________________________________________
E-Mail: ____________________________________________________________________
Key Contact: _______________________________________________________________
Membership Dues - Annual Rates (Check One)
Associate Membership: $750.00
| Mail this form with check payable to “NATO” or fax
with credit card information to: |
 |
National
Association of Tobacco Outlets
Fax: 952-934-7442 |
Credit
Card:
VISA
MasterCard
Discover
American Express
Card
Number: _______________________________________
Exp. Date: _____________
Notice: Pursuant to the 1993 Omnibus Budget Reconciliation Act provisions relating to lobbying expenses, the National Association of Tobacco Outlets, Inc. is required to advise you that 30% of your 2005 membership dues are not tax deductible.