CTANW Membership Form

Community Transportation Association of the Northwest provides services to and takes direction and guidance from our members. This membership form is designed to help provide our members and partners with the latest member benefits and opportunities. There are three (3) sections which request information to better enable CTANW to provide education, promote collaboration, and advocate for the interests of our members and the passengers and communities they serve. If you have any questions about this form, please email us at info@ctanw.org.
SECTION I: MEMBER INFORMATION
Member Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Website
Name of Designated Voting Representative*

First NameLast Name
Title*
E-mail*
Name of Alternative Voting Representative

First NameLast Name
Title
E-mail
SECTION II: ADVOCACY

CTANW collects demographic information to enable CTANW to create a stronger voice for our members.
Member or Organization Type*

Advocacy OrganizationAssociationBrokerCommunity Organization - OtherConsultantContract ProviderEducational InstitutionFor-HireFor-Profit Transportation ProviderFunding AgencyHuman/Social Services AgencyIndividualNonprofit Transportation ProviderPlanning AgencyPublic or Government Agency - OtherPublic Transit AgencyRegulatory AgencyTransportation Provider - OtherVendorOTHER - Please specify below
Member or Organization Type - Other
# of Employees
# of Volunteers
# of Trips Provided Annually
# of Vehicles Owned or Operated
Annual Revenue
Top 3 Funding Sources
Geographic Coverage or Service Area(s) - Please check all that apply

NE WashingtonNW WashingtonSE WashingtonSW WashingtonEastern WashingtonWestern WashingtonCentral WashingtonSeattleOregonIdahoStatewideNationalOTHER
Geographic Coverage or Services Area(s) - Other
SECTION III: DIRECTORIES

CTANW collects the following information to promote CTANW members, and to provide our collaboration, coordination and education services. We may or may not create a specific directory depending on the level of participation. Please select all that apply.
Potential Directories & Listings

Include me in the Emergency Management DirectoryInclude me in the Accessible/Specialized Transportation Provider DirectoryInclude me in the Mobility Management/Travel Training Services DirectoryList me as an Education/Training Provider (Please list your areas of expertise below).Include me in the Vendor/Sponsor DirectoryInclude me in the Peer-Mentor Director (Please list your areas of expertise below).Include our employment web page on the CTANW Jobs Site
Types of Education or Training Offered
Types of Products or Services Offered (I.E. - Brakes, Shocks, Buses, Propane, etc.)
Types of Peer Mentoring Offered (I.E - Mobility Management, Travel Training, Grants, Operations, etc.)
Employment Website Link
CTANW MEMBERSHIP LEVEL SELECTION & INVOICE

Option 1 - To receive a formal invoice and pay by check, please use Option 1. You will receive your invoice within 3-5 Business Days

Option 2 - To use this form as your invoice, and pay online, please use Option 2. NOTE: After you click submit you will be taken to the PayPal page. There is a small icon that allows you to select Credit/Debit card option, and you do not need PayPal to use the system. If you select this option, CTANW will only receive your membership form after the online payment has been completed.

*The membership categories are listed below. Transportation members can use their organization or their transportation department to determine the budget level.
OPTION 1 - INVOICE
Please use this option if you would like to receive an invoice and pay by check.
Please tell us the amount we should place on your invoice, and then click submit. (Note: The membership categories and amounts can be found at the bottom of this page.)
OPTION 2 - PAY ONLINE
Please use this option if you would like to use this form as your invoice, and submit your payment online. Please click on the correct Membership Level/Amount and then click submit below. This will take you to CTANW's PayPal page. Please only click submit when you're ready to make your online payment. If you do not complete the payment, CTANW will not receive your form.
OPTION 2: Online Payment
prevnext( X )
Individual (Non-Voting)$55.00

Individual (Voting Rights)$120.00

Vendors, Non-Transportation Partners + Associations $450.00

Transportation (Budget < $250K)$250.00

Transportation (Budget = $250K - $2Million)$450.00

Transportation (Budget = $2Million - $5Million)$650.00

Transportation (Budget > $5Million)$800.00

Government Agencies$300.00

Other (Separate Agreement)$ Free

Total $0.00
MEMBERSHIP CATEGORIES

TRANSPORTATION
Includes transit agencies, service providers and/or brokers.
o Mobility Management & Travel Training Programs
o Transportation Advocacy Coalitions, Associations & Groups
o Transportation Authorities
o Transportation Brokers
o Transportation Planning or Regulatory Agencies (including RTPO's/MPO's)
o Transportation Programs or Departments
o Transportation Providers (public, for-profit and nonprofit)
o Transportation: Other

NON-TRANSPORTATION PARTNERS & ASSOCIATIONS + VENDORS
o Technology, Vehicle, Insurance & Equipment Providers
o Advocacy Organizations - Non-Transportation
o Colleges
o Government Organizations
o Health Care Organizations
o Human Service Organizations
o Schools
o Other

INDIVIDUALS
o Independent Consultants
o Individuals Supporters & Donors

ADDITIONAL NOTES:

1. Member organizations each receive one vote. The member organization selects a “Designated Representative” to cast a vote on behalf of their agency.

2. Member organizations may select an “Alternate Representative” to vote on behalf of the organization in the event the “Designated Representative” is unavailable.

3. Individual members not representing an organization receive 1 vote.

4. State, City, County and Educational Institutions may fall into TRANSPORTATION or NON-TRANSPORTATION CATEGORIES. These government agencies may receive negotiated membership dues based on their level of involvement.

Thank you for joining Community Transportation Association of the Northwest, and our mission to bring together organizations, agencies, groups and individuals engaged in providing, developing and sustaining community transportation programs to enhance mobility and equalize opportunity for people with a variety of specialized transportation needs.
Should be Empty: