TML Associate Membership Application

Please Enter Your Information


	*	= Required field

Organization Profile

Organization Name:

Mailing Address:

City:

State/Province:

Zip/Postal Code:

Work Phone:

(111) 111-1111

Fax:

(111) 111-1111

Web Site:

Select membership type:

$300.00	Business - allows one contact to receive benefits.
$800.00	Corporation - allows up to four contacts to receive benefits.

Online Buyer's Guide Profile
Please select your organization categories
	Business Category 1
	Business Category 2
	Business Category 3
Briefly describe your organization to be displayed on our Website

Please list the individuals (up to four for Corporate Membership), including the principal contact individual, in your organization and their addresses, to receive a subscription to Texas Town & City magazine, TML Directory of Texas City Officials, TML Legislative Update and other TML publications.

Principal Contact Individual
Prefix:
First Name:	*
Last Name:	*
Title:
Phone:		(111) 111-1111
Fax:		(111) 111-1111
Email:
Address:
City:
State:
Zip:

Principal Contact Security
Login:	*
Password:	*

Contact Individuals (For Corporate Membership Only)
Prefix:
First Name:	*
Last Name:	*
Title:
Phone:		(111) 111-1111
Fax:		(111) 111-1111
Email:
Address:
City:
State:
Zip:

Prefix:
First Name:	*
Last Name:	*
Title:
Phone:		(111) 111-1111
Fax:		(111) 111-1111
Email:
Address:
City:
State:
Zip:

Prefix:
First Name:	*
Last Name:	*
Title:
Phone:		(111) 111-1111
Fax:		(111) 111-1111
Email:
Address:
City:
State:
Zip: