STA / Contact

STA online membership application

Your Name:
Name of Firm:
Home Office Address:
City, State, Zip Code:
E-Mail Address:
Telephone with Area Code:
FAX with Area Code:

Choose Proper Business Org:
State of Incorporattion:
List Owners, Partners, or Officers:
List Owners, Partners, or Officers:
List Owners, Partners, or Officers:
List Owners, Partners, or Officers:
List Owners, Partners, or Officers:
Business Start Date:
Change of Ownership in Last Year?
If Yes, Former Owner Name:

Primary Contact Name:
Secondary Contact Name:
Type of Equipment Used:
Number of Positions:
User Group Affiliation:
ATSI Member:
Local Telephone Service Provider:
Do You Provide Paging Service?
Are you a licensed RCC or Reseller:

Dues are Based on Total Number of Employees (including owners):
How many Employees?

After the first year, your renewal choices are Annual or Quarterly Billing: (Quarterly Billing will incure a $5 service per quarter for processing)
Select Your Renewal Preference:

If paying by Check, Please complete and print this application and mail it with your check for 1 year dues plus a $10 enrollment fee to:
Southern Telemessaging Association PO Box 46443 Plymouth, MN 55446-0443
You may also complete, print and FAX your Application to (763) 476-2193 with credit card information

Payment Options:

I authorize STA to charge the below credit card with the membership choice made on this page.
Credit Card Number:
Expiration date:
Name on Credit Card:
Billing Zip Code:

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