2015 Convention Program 2015 Convention Program | Page 68
TEXAS PACKAGE STORES ASSOCIATION
2015 APPLICATION FOR MEMBERSHIP
Schedule of Dues
No. of Stores:
1
2–4
5–9
10 and over
Date: ______________________
Number of Stores: ___________
Dues:
$100
$125 per Store
$150 per Store
$175 per Store
You must join for all
stores you have.
I hereby make application for membership in the Texas Package Stores Association and enclose my check in the amount of
$_________________ or have completed the Credit Card Information Form.
Select payment method:
[ ] Check
[ ] Credit Card
Trade Name:
Corp./Owner Name:
Address:
City, State, Zip:
County:
Phone:
Fax:
E-mail:
By signing below, I certify that the package stores for which application is made are:
1.
2.
licensed as package stores by the State of Texas, and
at least 51% owned by Texas citizens (i.e. 51% owned by individuals who are residentially domiciled in the State
of Texas, and who have continuously been residentially domiciled in the State of Texas for the immediately
preceding year).
Membership to be
represented by:
(Must be a member or employee of your firm)
Title:
Signature of applicant:
Printed name and Title
of person signing:
This form may be returned by mail to TPSA, 1122 Colorado St., Suite 313, Austin, TX 78701, faxed to (512) 474-0717 or scanned and
emailed to [email protected]. Thank you.
Dues payments to TPSA are not deductible as charitable contributions under the Internal Revenue Code. Because a significant
portion of TPSA dues are used to lobby the legislature in issues important to package stores, TPSA dues are generally not deductible
under Internal Revenue Code. Consult your tax advisor for complete information.
68-2015 TPSA Covention