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Membership Application Form

Organization Name*
Contact Person/Title*

First
Last
Address*

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone Number*

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Fax Number

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Website
Email
 I certify that I have received a copy of the By-Laws of the Illinois Public Transportation Association, and that our organization agrees to abide by said By-Laws.  
Membership Level

Regular members’ contributions shall be based upon actual transportation expenses excluding capital from the previous fiscal year as follows:

Over $5,000,000................................... $8,500.00
$2,500,000 -$5,000,000.................... $4,400.00
$1,000,000 - $2,500,000....................$2,400.00
$500,000 - $1,000.000...................... $900.00
$ 250,000 - $500,000........................ $450.00
$ 100.000- $ 250,000........................ $350.00
Under $100,000.................................. $300.00

Associate members’ contributions shall be fixed for the following categories:
a. Corporate $500
b. Professional $200
c. Government/Planning $150
d. Individual $ 25
e.Honorary Membership’s No Charge

However, new associate members joining on or after any January 1 of any fiscal year shall be assessed a pro-rated contribution for that fiscal year.
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