TAPBA Membership Application

TAPBA Membership Application

For fiscal year July 1, 2023, through June 30, 2024
You must complete this form by December 31, 2023, to be eligible to vote in the May 2024 election.
Name*

First NameLast Name
Date Qualified to Write Bonds*

MonthDayYear
Date
Company Name
Owner Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Counties in which You Write Bonds
Judicial Districts in which You Write Bonds
TAPBA's Fiscal Year runs from July 1 through June 30 of each year. Voting memberships are non-transfereable.
Please select one of the following:

Company MembershipAgent Membership (No Charge)
Please select type of company membership:

1 Year ($100)3 Years ($250)5 Years ($400)Lifetime ($1,000)
It is often important to identify members who are constituents in different legislative districts. Your response is greatly appreciated. The informaiton requested can be found on your voter registration card or at www.legisliature.state.tn.us then "Find My Legislator."
State House District #
State Senate District #
Political Party Affiliation

DemocraticRepublicanIndependent
Payment Options

CheckCredit/debit card
Please make checks out to TAPBA and sent to:

P.O. Box 60128

Nashville, TN 37206

Membership Options

1 Year Company Membership

$100.00

3 Year Company Membership

$250.00

5 Year Company Membership

$400.00

Lifetime Company Membership

$1,000.00

Total

$0.00

Credit Card

Apple Pay

Google Pay