Application To view this form, please enable JavaScript in your browser. Organization Information (to be displayed online) Organization Name First Name Last Name Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Fax Website Email Membership Investment Membership Type Select one... In-State Motor Carrier Company Out-Of-State Motor Carrier Company Allied Company Primary Directory Category None Allied Governmental Agency Legislators Motor Carrier State Associations Number of Straight Trucks *includes owner operators/leased units* Number of Tractors *includes owner operators/leased units* Missouri Mileage Percentage % Fee Total Minimum Annual Dues of $500 Applied. The contents of this box are for testing purposes. This box will be removed when the form goes live. Percentage of Missouri Mileage Any Additional PAC Donation Amount Annual Membership Investment Sales Volume (of largest store) Number of Locations Company Annual Sales (in Millions) Additional Items Additional Directory Categories Select additional directory categories below by holding the "CTRL" key Secondary categories may be subject to additional fees none Additional Categories Cost One-Time Application Fee Enhanced Membership ($50) Full-Time Employees Part-Time Employees Hotel/Motel Rooms Restaurant Seats Additional Associates Additional Associates Cost Additional Locations Additional Locations Cost Assets Assets Cost Additional Categories Number Of Additional Categories Additional Categories Cost Additional Item 1 Cost Additional Item 2 Cost Additional Item 3 Cost Additional Item 4 Cost Additional Item 5 Cost Additional Item 6 Cost Additional Item 7 Cost Additional Item 8 Cost Additional Item 9 Cost Additional Item 10 Cost Annual Dues (charged to card) Revenue Item CC Fee (charged to card) Fee (charged to card) Temp Value For DropDown 1 MembershipType Additional Item 2 Additional Item 3 Additional Item 4 Additional Item 5 Additional Item 6 Additional Item 7 Additional Item 8 Additional Item 9 Additional Item 10 Number of Full Time Employees Number of Part Time Employees Political Action Committee Payment Type Credit Card Check NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks. Credit Card Information Credit Card Type MastercardVisaDiscoverAmex Credit Card Number Name on Card Security Code Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Credit Card Email Address For federal income tax purposes, your investment in the Association is deductible as a business expense, not as a charitable contribution. Under provisions of the 1993 federal tax law, however, it is estimated that 19% of your membership dues are not deductible because of lobbying activities of the Association. Congress, in effect, placed a tax on your right to petition the government. Please click submit only one time. The transaction may take several seconds.