
The Missouri Telecommunications Industry Association (MTIA) invites you to submit this Application to become a member of MTIA. Please provide the information requested and return this completed form, along with your dues check, in the amount of $300, to the following address:
Missouri Telecommunications Industry Association
P.O. Box 785, 312 E. Capitol Ave.
Jefferson City, MO 65102
Upon approval of your application, you will be notified and enrolled as a member of the Association. At that time, further information will be requested for purposes of the Association Membership Directory and future correspondence.
Name of Company:

|
Mailing Address:

|
City:
 | State:
 | Zip Code:

|
Phone/Fax:
 |
Primary Contact Person:
 | Title:
 |
E-Mail:
 | Web Site:  | |
Category III Member 2008 Calendar Year Dues: $300 | |
Any individual, firm, partnership, corporation or cooperative, with interests in common with the organization, and providing services to current Category I or Category II members, and not otherwise eligible for Category I or Category II membership, is eligible to become a Category III member. |
Type of Services Provided (25 Words or Less):

|
| Mark the box beside the services your company offers: | |
|
Signature:

| Date:

|
Dues to the Missouri Telecommunications Industry Association are not deductible as a charitable contribution for federal income tax purposes, but may be deductible as an ordinary and necessary business expense. A portion of dues, however, is not deductible as an ordinary and necessary business expense to the extent that Missouri Telecommunications Industry Association engages in lobbying. The non-deductible portion of dues for 2008 is five percent (5%).
For your information:
Category I Member
Any individual, firm, partnership, corporation or cooperative owning and/or operating a local exchange telecommunications company authorized to provide basic local telecommunications service in a specific geographic area in the State of Missouri as of December 31, 1995, or a successor in interest to such a company, is eligible for A Category I Membership in this Association.
Category II Member
Any individual, firm, partnership, corporation or cooperative is eligible to be a Category II Member if it is operating as a telecommunications company, is authorized to do business in Missouri, and is engaged in any of the following principal lines of business: local exchange and/or basic local telecommunications service (but not eligible as a Category I Member); interexchange telecommunications service; wireless telecommunications service; competitive access provider; cable TV company; or any other telecommunications company as may be approved by the Board of Directors.
For additional information on membership, please call the MTIA Office at (573) 634-2527/Fax (573) 634-5792.
|