Gold Coast Membership Application Renewal

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					                                                                    PLEASE STAPLE YOUR BUSINESS CARD HERE




                           MEMBERSHIP APPLICATION & RENEWAL FORM
                            **PRINT CLEARLY**: ALL APPLICATIONS MUST BE FULLY COMPLETED

NEW ___________          RENEWAL       ______________________       DATE    _________________________________

MISSION STATEMENT: TO BRING TOGETHER MEMBERS WITH TRAVEL RELATED BUSINESS FOR PURPOSE OF NETWORKING, CONTINING
EDUCATION, AND PROFESSIONALISM WITHIN THE TRAVEL INDUSTRY.

NAME                               ______________________________________________________________________

BUSINESS NAME                      ______________________________________________________________________

BUSINESS ADDRESS                   ___________________________________ CITY__________________ ZIP __________

BUSINESS TELEPHONE                 __________________________________ BUSINESS FAX ________________________

IMMEDIATE SUPERVISOR               __________________________________ TITLE         ___________________________

YEARS EMPLOYED IN TRAVEL INDUSTRY ____________________ YEARS AT CURRENT EMPLOYER _____________________

NUMBER OF HOURS PER WEEK DEVOTED TO THE PROMOTION OF TRAVEL                 __________________________________

HOME ADDRESS _________________________________________________ CITY _________________ ZIP ____________

HOME TELEPHONE _______________________________________________ HOME FAX ___________________________

E-MAIL ADDRESS** _______________________________________________ BIRTHDAY: MONTH________ DAY_______

PLEASE MAIL CORRESPONDENCE TO:         HOME ______           BUSINESS _______

BRIEFLY STATE WHY YOU ARE INTERESTED IN BECOMING A MEMBER OF GOLD COAST TRAVEL INDUSTRY ASSOCIATES
(NEW MEMBERS ONLY) _________________________________________________________________________________

____________________________________________________________________________________________________

SPONSORED BY _____________________________________           MEMBERSHIP DUES:

NEW MEMBERS OR PAST MEMBERS WHO ARE NOT CURRENT MEMBERS:                    $40.00
CURRENT MEMBER RENEWALS:                                                    $25.00 – IF PAID BY DECEMBER 31TH
                                                                            $40.00 – IF PAID AFTER DECEMBER 31TH

                            ******** ALL MEMBERSHIPS EXPIRE ON DECEMBER 15TH ********
                                  (VIEW BY-LAWS IN BY-LAW SECTION ON THE WEBSITE)
  I HAVE READ THE BY-LAWS, CODE OF ETHICS, AND FAMILIARIZATION CODE OF ETHICS OF GOLD COAST TRAVEL INDUSTRY ASSOCIATES.

  MAIL APPLICATION TO:

  Jack Brown
  Atlas Travel
  2671 E. Commercial Blvd.                                           _________________________________ PLEASE SIGN
  Ft Lauderdale, Fl 33308
  PHONE: 954-776-7666

				
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