Or use this form to contact us directly

Business Name:

Tag Line:

Contact:

 Title:

Type/Description of Business:

Mailing Address:

City, State Zip

Physical Address, if different:

City, State Zip

Phone:  Fax: Email:

Web Address

Insurance Agency
If under Anthem VAP

No. of VA Locations

   No. of VA Employees::

Legislative Contact,if different:

Phone:  Fax: Email:

How  do you want to receive the Newsletter: Regular Mail     Email

How  do you want to receive the Legislative Alert: Fax           Email

What version of the report do you want: Complete Report    Abreviated Report

Send Newsletter Only. Do not send legislative updates/report Yes   No

Membership Fee Schedule

Less than 50 employees: $75 per year      |      51+ employees $100 per year

 

Signature of proposed member: _______________________________________- Date: ________________________

 

Signature of RMA Acceptance: ________________________________________ Date: _________________________

Special Instructions:

Membership Dues in the Retail Merchants Association (RMA) cover a 12 month period that begins with the anniversary date of your membership.  Payments to RMA are not deductible as charitable contributions for federal income tax purposes. The RMA estimates that 15% of your membership dues are not tax deductible for any reason under new IRS regulations related to lobbying expenses; however, the remaining 85% may be deductible as an ordinary and necessary business expense.