MAPSA Membership Application Form


MEMBERSHIP APPLICATION FORM

The undersigned firm hereby applies for membership in the *Midwest Automotive Parts & Service Association* in order to participate actively in the affairs of our industry and share in the benefits and services of association membership.

FIRM NAME
STREET ADDRESS
CITY
STATE
ZIP
PHONE
CELL PHONE
CELL PHONE CARRIER
FAX
EMAIL
OWNER
MANAGER

MEMBERSHIP IS CONTINGENT UPON ENDORSEMENT OF THE MAPSA MEMBERSHIP COMMITTEE.

Dues are not deductible as Charitable Contributions for Income Tax Purposes.
Dues may be considered ordinary and necessary business deductions.

MEMBERSHIP TYPES & DUES SCHEDULE

ACTIVE MEMBERSHIP (JOBBERS/WD’s)
Please select one from the following schedule:



BRANCH MEMBERSHIP
	1 — 5 Branches @$45.00each (annual)

	BRANCH GROUP MEMBERSHIP Over 5 Branches $270.00 (annual)

ASSOCIATE MEMBERSHIP $215.00 (annual)
(Manufacturers, MAPSA Suppliers, Sales Representatives,
Repair Facilities, Body Shops, Full-Service Stations, Tire Dealers,
Glass Shops, and other related industries.

ADDITIONAL MAILING SERVICE
(Only For Active & Associate Members) $25.00 (annual)

To determine the number of persons on which dues will be paid:

Add the number of fulltime (30 or more hours per week) employees
in the Main Store, including owners, officers, and office personnel

… and the number of employees in all the Branch/Affiliate Stores, regardless of size or location.

- denotes required fields