Indianapolis Traffic Club

Indianapolis Traffic Club
PO Box 2542
Indianapolis, IN 46206

2012 Membership Application

ITC Objectives: To promote mutual understanding and friendly cooperation among shippers,
carriers and allied industries. To stimulate education in transportation and economies.

CLICK HERE if you want to complete the PRINTABLE VERSION instead.

Company Name

* First Name

* Last Name

* Phone (please add ext. if needed)

* Email Address

* Billing Address

* City

* State

* Postal Code

* Billing Email Address

* Billing Contact Phone

Mailing Address (If Different )

City

State

Postal Code

Each member will receive the benefits of being part of the Indianapolis Traffic Club for one full year. Please indicate how many people within your company you are signing up, including yourself:

Please complete the information needed for the other people you are signing up.

First Name

Last Name

Phone (please add ext. if needed)

Email Address

* Would you like to provide your home address for our records?

Home Address

City

State

Postal Code

First Name

Last Name

Phone (please add ext. if needed)

Email Address

* Would you like to provide your home address for our records?

Home Address

City

State

Postal Code

First Name

Last Name

Phone (please add ext. if needed)

Email Address

* Would you like to provide your home address for our records?

Home Address

City

State

Postal Code

First Name

Last Name

Phone (please add ext. if needed)

Email Address

* Would you like to provide your home address for our records?

Home Address

City

State

Postal Code

To help keep costs down and be more eco-friendly, we will automatically email you with event updates, newsletters, and any other publications. If you would still like to receive info by mail, please check the box below.

In addition to email, please mail me all publications.

How did you hear about us? Please type the name of the person who recommended you to join the ITC:

For all membership, there is a $30 membership fee. Sign up 4 or more members within a company and you will receive a $5 discount per member.

Once the form is submitted, you will have the option to pay with a credit card. Please indicate below if you would prefer to be invoiced instead.

I will pay by check

I will pay with Credit Card

* Indicates Response Required