Exhibitor Registration and DTDA Membership Form

Use this form to pay by credit card securely now.

You can use this form to join as a member of DTDA, renew your membership, and to register for national convention*, or register for regional conferences*. After completing this form, you will be prompted to pay on-line securely using your credit card. You must complete all information and payment must be received in order for us to process your membership. Thank you!

Directors should use the General Membership and Convention/Conference Registration Form.

Exhibitor Registration Form-
Type in fields and submit form electronically (pay by credit card), OR type in fields, print form and mail in with payment.

Company Name required
Representative		Toll Free #
Address		Local Phone #
City		Fax #
State		Email Address: required
Zip		URL Address for website
Nature of Business
Membership Status	New Member	Sustaining Member Since	(insert year)

Required Annual Membership Fee
$	DTDA Membership- $50 annual fee, please check.
Enter any additional payments or contributions to DTDA
$	NASDT Scholarship Contribution
$	OTHER PAYMENT - If you have an outstanding invoice for advertising or other DTDA service, and would like to pay by credit card, please enter the amount owed left and the invoice number to the right.	INVOICE NO.
$	Total Payment

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