National Association of Corporate Treasures: Join NACT

Membership Application

Please print, complete, and mail or fax the application to:

NACT/Wachovia
PO Box 758919
Baltimore, MD. 21275-8919

CONTACT INFORMATION

* = Required Fields

First Name: *

Last Name: *

Title:

Email: *

Company:

Address 1: *

Address 2:

City: *

State: *

Zip: *

Country:

Telephone: *

Fax:

COMPANY PROFILE

(Please check the appropriate box under each heading.)

Industry

Manufacturing (1)

Insurance (2)

Retail (3)

Service Organization (4)

Finance (5)

Utilities (6)

Transportation (7)

Other (8) (Specify):

Assets

$100M or Less (1)

$101–500M (2)

$501–999M (3)

$1–5B (4)

Over $5B (5)

Revenues

$1–99M (1)

$100–499M (2)

$500–999M (3)

$1–5B (4)

$5-10B (5)

Over $10B (6)

Credit Rating

AAA (1)

AA (2)

A (3)

BBB (4)

BB( 5)

B (6)

Not Rated (7)

Ownership

Public (1)

Private (2)

Nonprofit (3)

Primary Business:

AREAS OF RESPONSIBILITY

(Please check all areas in which you are involved.)

Cash Management	Corporate Finance
Credit	International Currency Management
Employee Benefits	Financial Risk Management
Insurance	International
Investor Relations	Payables
Pensions	Receivables
	Other

	I perform all or a substantial part of the duties of corporate treasurership in my company. (Regular Member)
	I perform part of the duties of corporate treasurership in a company with annual revenues over $10 billion. (Regular Member)
	I perform part of the duties of corporate treasurership and another individual from my company is a regular member of NACT. (Associate Member)

GEOGRAPHIC DISTRIBUTION

(Please check the row that includes your state.)

MA	(1)	DC, DE, MD, Southern NJ, Eastern PA, VA
MW	(2)	IA, IL, IN, KS, Western MI, MN, MO, ND, NE, SD, WI
NE	(3)	Northern CT, MA, ME, NH, RI, VT
NY	(4)	Southern CT, Northern NJ, NYC, NY State
OV	(5)	KY, Eastern MI, OH, Western PA, WV
PN	(6)	AK, Northern CA, ID, MT, OR, WA
SC	(7)	AZ, Southern CA, HI, NV
SE	(8)	AL, FL, GA, MS, NC, SC, TN
SW	(9)	AR, CO, LA, NM, OK, TX, UT
I	(10)	International

PAYMENT INFORMATION

Dues

$500 / one year

Payment Method

My check is enclosed for the above amount, made payable to the National Association of Corporate Treasurers.

Charge the above amount to

Credit Card Type: *

Master Card Visa

Card Holder Name: *

Credit Card Number: *

Expiration Date: *

Card Holder Signature: *