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Associate Members Profile
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Company Name:
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Name of Contact Person:
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Position:
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Address:
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City:
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State/CD:
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Zip:
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Country Name:
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Work Phone:
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Toll Free:
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Fax Phone:
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Email:
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Website:
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Chapter Affiliation(s):
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Referred By:
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2010 Associate Membership Dues ______x $50.00
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I will be paying by:
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Total Dues:
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| CHECKS PAYABLE TO APTA Please send to: Yvette De Vries Director of Corporate Membership African Portfolio 146 Sound Beach Avenue Old Greenwich, CT 06870 USA WIRE TRANSFERS: (Please add $25.00 to your payment for bank fees) Bank: The Suffolk County National Bank 74 Echo Avenue Miller Place, New York 11764 Phone: 631-474-8400 Account: Association for the Promotion of Tourism to Africa. Account: # 1320011347 Routing: # 21405464 Thank you for your prompt payment! |
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