NATO
Associate Membership Application
(Use this form if your company is primarily engaged in the business of providing services or non-tobacco related ancillary products to tobacco retail stores)
Company
Address
City
State
Zip
Telephone
Fax
Email
Key Contact
Annual Membership Dues
Total Dues Amount:
$1,150.00
Payment
Type
Mail this form with check payable to "NATO" to:
National Association of Tobacco Outlets
c/o Kleinfeld Kaplan & Becker
1850 M Street NW, Suite 1000
Washington, DC 20036
National Association of Tobacco Outlets
c/o Kleinfeld Kaplan & Becker
1850 M Street NW, Suite 1000
Washington, DC 20036
Card Type
Card #
Exp. Date
Billing Address
City
State
Zip
Signer's Name on Card
Signature
Fax this form to: 952-487-0123 or Email to: david.spross@natocentral.org
Pursuant to federal law, NATO is required to advise you that 40% of your annual membership dues are not tax deductible.