MEMBERSHIP APPLICATION

Member Information and Member Contact

Company:

Name:(Primary Contact)Title:

Mailing Address:

City:State:Zip:

Phone:Email:Website:

Please provide a .gif or .jpg file of your Company’s logo for the ATI website. The logo, along with the above contact information will be posted to

Membership Type and Dues:

/ Full Member I
Public agency operating
a toll facility / $2,500.00
Annually / Full Membership I Status includes:
  1. Access to all ATI Member Meetings with a voting seat
  2. Ability to serve on the ATI Board of Directors
  3. Ability to participate in all ATI Initiatives, Pilot Programs, etc.
  4. Access to ATI’s website and any private documentation that may be provided

/ Full Member II
Private Toll Operator
operating a toll facility on behalf of a government
agency / $2,500.00
Annually / Full Membership II Status includes:
  1. Access to all ATI Member Meetings with a voting seat
  2. Ability to participate in all ATI Initiatives, Pilot Programs, etc.
  3. Access to ATI’s website and any private documentation that may be provided

/ Associate Member
Private Toll Operator / $1,875.00
Annually / Associate Membership Status includes:
  1. Access to all ATI Member Meetings without a voting seat.
  2. Access to ATI’s website and any private documentation that may be provided

/ Trade Organization Partnership / NA / Please email for more information.

Additional Member Contacts:

Financial Point of Contact
Name:
Phone: / Title:
Email:
Name:
Phone: / Title:
Email:
Name:
Phone: / Title:
Email:
Name:
Phone: / Title:
Email:
Name:
Phone: / Title:
Email:
Name:
Phone: / Title:
Email:

Submit the membership application, company logo and payment to:

Alliance for Toll Interoperability

Attn: Membership

PO Box 14468

Durham NC 27709

By signing this membership application, the company indicates their formal intent to join the Alliance for Toll Interoperability (ATI). Signing of this application ensures the appropriate authority to join ATI. Further, the company has reviewed the Articles of Incorporation and Bylaws of ATI. As defined by these documents, the company meets the necessary qualifications to become a member of ATI. Membership must be cancelled only by notification in writing submitted to the address or email listed above and is complete once the member has submitted the Membership Exit Survey.

______

SignatureDate

Alliance for Toll Interoperability

P.O. Box 14468 - Durham, North Carolina 27709

- 919.441.6542

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