Membership Application Form

Membership Application

To apply for membership please complete all questions.
Name of Firm:
Home Office Address:

Street Address

Street Address Line 2

CityState

Zip Code
E-mail:
example@example.com
Phone:
Sole ProprietorshipCorporation or LLC
State of Incorporation:

Street Address

Street Address Line 2

CityState

Zip Code
Cellular Number
List of Owners, Partners or Officers:
Date of Commencement of Business:

MonthDayYear
Date
YesNo
If Yes, former owner name:

First NameLast Name
Name of Primary Contact/Representative:

First NameLast Name
Name of Secondary Contact/Representative:

First NameLast Name
Signature of Applicant:*

Applicant states that the information provides herein regarding the nature and extent of his/her business is true, and if approved, agrees to abide by the By Laws of the Association.
Title of Applicant
Signature Date

MonthDayYear
Date
Equipment Used:
Number of Positions:
User Group Affiliation:
YesNo

Membership Dues

Pro-rated dues as appropriate based on fiscal year of Jan 1 to Dec 31.
Payment Options:*
Paying by credit card, please email Dan L’Heureux, President at Dan@callconsult.net
or call 800.483.4135.

If paying by check please send your invoice, check for annual dues & $10 Enrollment Fee to:
Great Lakes TeleServices Association
3500 Vicksburg Lane #409 Minneapolis, MN 55447-1334
Membership Dues*
prevnext( X )
Enrollment Fee
One-Time Fee

$10.00

Annual Dues
$200.00

Total

$0.00
Should be Empty:

Membership Application