2025 MARKETER MEMBERSHIP APPLICATION

Marketer Membership Application

PRIMARY CONTACT INFORMATION
Company Name*
DBA
PRIMARY CONTACT *

First NameLast Name
PRIMARY CONTACT PHONE*
Please enter a valid phone number.
FAX NUMBER (IF APPLICABLE)
Please enter a valid phone number.
PRIMARY CONTACT ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
COUNTRY (if not in the USA)
PRIMARY CONTACT EMAIL ADDRESS*
example@example.com
SELECT PREFERRED METHOD OF COMMUNICATION*

SECONDARY CONTACT (IF APPLICABLE)
SECONDARY CONTACT INFORMATION - Please list name, email and phone number.
Check if address of secondary contact is the same as primary. If not - please add secondary contact's address below.

SAME AS ABOVEOther

OPERATIONS INFORMATION
Number of Bobtails Operated:Number of Bobtails Operated Bobtails

Number of Transport Trucks Operated:Number of Transport Transports

Current Number of Form 4 Decals Current Number of Form 4
Does the truck count above include branch operations

YESNO
NPGA dues:# of bulk storage # of Bulk Storage (s)
Is your company new to the industry, did you:

Start a new businessPurchase another license operation - Please Name Company

PAYMENT
PAYMENT/INVOICE

TPGA's accountant will invoice you for membership dues. Once payment has been confirmed/received, a confirmation email will be sent to you to acknowledge membership.

How did you hear about TPGA?
How did you hear about TPGA?*

TPGA WebsiteTPGA PublicationTPGA StaffFacebookInstagramLinked-InTPGA MeetingPSC PurchaseReferred by TPGA Member - Please list member name
Should be Empty: