Application for Membership
National Defense Transportation Association
50 S. Pickett Street · Suite 220 · Alexandria, VA 22304-7296
(703) 751-5011 · FAX (703) 823-8761

Name: MR. MRS. MS.  ______________________________________________________________

Title/Rank/GS Grade  _______________________________________________________________________

Organization _____________________________________________________________________________

Mailing Address __________________________________________________________________________

City __________________________________ State ___________________  Zip ______________________

Phone: Work (_______) ___________________________ Home (_______) ___________________________

Email: Work ____________________________________ Home ____________________________________

Birth Date: _____/_____/_____ Chapter Affiliation: _______________________________________________

Membership Type $400.00 - LIFE $99.00 Regular (3 Years) $35.00 Regular (1 Year) $20.00 SPECIAL RATE Military A-35 (Pay Grade 03 & below including enlisted.) Active Duty Active Reserve Active National Guard Govt. Employee A-35 (Pay Grade GS-10 & Below) Under 35 Years of age Retired (Not gainfully employed.) $10.00 Full Time Student Amount Remitted $___________________ Organization: Air Consulting Education Freight Forwarder/Express Government Civilian Highway Industrial Traffic Management Lodging/Hospitality Manufacturing Marine Military Passenger/Travel Services Pipeline Rail Technology Other: ___________________________ Please consider adding $1.00 for the Foundation. Check# _________________________________________ VISA    MasterCard    American Express Card No:    Exp. Date: Cardholder's Name: ______________________________________________________________________ Signature: _____________________________________________________________________________