Associate Member Application

To join CTIA, please complete this membership application. Contact CTIA at membership@ctia.org or call (202) 736-3200 if you have any questions.

Organization

Organization Name

Website

Description*

Primary Contact

First Name

Last Name

Title

Phone

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Payment Method

Associate membership dues: $6,000

CTIA's Fiscal Year and Membership period runs from January 1 through December 31. Dues are not subject to proration. Based on IRS rules and regulations, dues paid to CTIA are not deductable as a business expense.

Pay by check

Make check payable in US Dollars to CTIA on a US bank and mail to:

CTIA
Attn: Member Benefits
1400 16th Street NW, Suite 600
Washington, DC 20036

Pay by credit card or e-check

We will send you a secure link to pay online.

Pay by wire

We will send you an invoice with wire payment details.

Billing Contact

For CTIA dues

Same as primary contact

First Name

Last Name

Title

Phone

Comments

(Optional)

Submitted by

Same as primary contact

First Name

Last Name

Title

Phone

By submitting this form, I certify that all information is correct and that my company intends to apply for CTIA membership.*

Please confirm you agree before proceeding.

Please correct the highlighted fields before proceeding.

Associate Member Application

Organization

Primary Contact

Payment Method

Billing Contact

Comments

Submitted by

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Application submitted