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JOIN ASSIST ASSIST - Membership
Committee Please accept my application for enrollment in ASSIST: Membership Year: January 1, 2_________ through December 31, 2_________ ______ Regular Member ($150.00) ______ Associate Vendor Member ($250.00) ______ Associate Employee Member ($25.00) Name: _________________________________________________ Title: _________________________________ Company: ______________________________________________ TCPS License #: _______________________ Address: ______________________________________________________________________________________ City, State, Zip: ___________________________________________________ County: ______________________ Telephone: ________________________________________ Fax: _______________________________________ E-mail Address: ____________________________________ Website: ____________________________________ Social Security #: ___________________________________ (Required for C.E. Certificates)
Telephone Number:
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Regular Members: � ASSIST
Messenger Newsletter (published quarterly) Associate Employee Members: � Your are
eligible to receive a $10,000
Accidental Death and Dismemberment Policy |