MEMBERSHIP APPLICATION

General Information: (* = required field)

Name: Last*	First*
Job Title:
Company:*
Street Address /P.O. Box*
City *
State*	Zip*
Phone:
Fax:
Email:*
Company product/service:

Membership Information:

Prime Contractor to Government Agency
Agency:
	DOD
	NASA
	DOE
	DOT
	Other
Commercial Company
Not for Profit
Other:

Annual Dues: $150.00
Make check payable to:	ASDP, Inc. Non-Profit Status 501(c)(3) Tax #20-0065647
Send by U.S. Postal Service to:	P.O. BOX 782049, Orlando, FL 32878-2049

Please be sure to reference your name somewhere on the check. You may want the invoice number to be your first initial and last name.