NAGASA Membership Application Form

Nagasa ** Fill out this Membership Application Form and submit below, or go to the Print Version of this form, print, fill out, fax/send to NAGASA at:

NAGASA 1604 New Hampshire Avenue NW, Washington DC 20009
Voice 202/328-8441 Fax 202/328-8513

We hereby make application for enrollment as a Member in NAGASA and, if elected, agree to abide by its Bylaws. Our firm shall be invoiced for its membership dues following acceptance of our application. Firms granted membership shall have their first year's dues prorated from November 1 to October 30 accordingly.

Company/Organization :
Parent Company:
Year Founded:
Street / Shipping Address:
Mailing Address (If different from above):
City:
State / Province:
Zip + 4 / Postal Code:	-
Country:
Switchboard:
800-line:
Fax:
Web Address:

Primary NAGASA Representative

The primary NAGASA Representative serves as the principal contact and receives all NAGASA communications.

Name:
Title:
Direct Phone:
Direct Fax:
Direct E-mail:

Please mail branch and other locations to be listed in annual directory.

How Did You Here About NAGASA?

Industry Trade Show (indicate show name and place)
NAGASA Promotion or Mailing
Referred By
Other (please describe):

Representatives
Firms are provided membership services to other representatives. Please attach mailing addresses, telephone/fax/e-mail numbers, and contact names and titles. Dealer, reseller, and VAR outlets will be listed in the NAGASA Membership Directory and Web Site.

Rules of Membership

Full membership shall be open to any firm, corporation, or division of a corporation engaged, within North America, in distribution or manufacturing (and importing) for distribution of graphic arts, printing, and imaging products.

Membership will remain in force for one year and thereafter shall be renewed automatically from year to year on November 1st unless terminated in writing.

Dues shall be based on a member's sales of equipment, supplies, systems, software, paper, and services sold through distribution.

NAGASA and PESDA, Printing Equipment & Supply Dealers' Association of Canada, operate under joint membership. Canadian firms are required to be members of PESDA and automatically become a NAGASA member. Please complete this membership application and NAGASA will forward to PESDA.

Please complete the Membership Dues Classification section.

Annual Membership Dues
Deductible as a business expense since NAGASA does not engage in lobbying.

Check if applies: Active Member
Dues rate based on Sales Volume.

Select One:

Sales Volume (Check box)
Dues shall be based on a member's sales of equipment, supplies, systems, software, paper, and services sold through distribution. All sales data strictly confidential.

Annual Dues:
$0 to $2.0 million.....................$462
$2.1 to $5 million.....................$924
$5.1 to $10 million...................$1,324
$10.1 to $25 million.................$1,782
$25.1 to $50 million.................$2,640
$50.1 to $100 million...............$3,960
$100.1 to $250 million.............$6,600
Over $250 million....................$8,250
Currently our firm does not sell through distribution; however, it is our intention and plan to distribute our products through the channel.

Check if applies: Associate Member
Publishers & Associations............U.S. $462
Organizations that publish information or provide association services of interest to the graphic arts, printing, imaging and related industries.

Select One:

*Dues rate based on one individual only. Sales volume rates above apply to corporate entities. (If applicable, please check sales volume rate above.)

Check box:We agree to the Rules of Membership.
Signature:Date:

Submit this information to NAGASA, or go to Print version of
this application, fill-out and send/fax to the above address.

to Becoming A Member