Application For Membership

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By completing this form, I am consenting to and giving IADAC/NIADA, its affiliates and subsidiaries, my permission to (until I give written notice to discontinue) contact me and provide information to me at the mailing and e-mail address, telephone and fax number I have provided.

I certify that (I am/we are) eligible for membership in IADAC.

I understand that a portion of my dues may be used for lobbying activities as defined by the Revenue Reconciliation Act of 1993. It is estimated that the percentage used for such purposes will be 22.8%. This portion of my dues is not deductible as ordinary and necessary business expense.

Contributions and/or gifts are not deductible as charitable contributions for federal income tax purposes.

Email *

Your Full Name *

Your Phone Number *

Legal Name Of Your Dealership or Company *

Do You Operate Under A DBA (Doing Business As)? *

Yes

DBA Name (if applicable)

Dealer License Number (Vendor/Associate Applicant, Please Type XXXXX) *

Dealership or Company Street *

Dealership or Company City *

Dealership or Company State *

Dealership or Company Zip Code *

Mailing Address Same As Address Provided Above? *

Yes

Mailing Address Street (if different)

Mailing Address City (if different)

Mailing Address State (if different)

Mailing Address Zip Code (if different)

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