INSTRUCTIONS: Print this application form, complete, sign, and mail it with the appropriate dues to the STAA office. Membership year begins April 1. Dues for new members only may be pro-rated to the nearest previous quarter, i.e., applications filed in August would incur 75% of the annual dues for a membership category; applications filed in November incur 50% of annual dues.

Application name ________________________________________________________

Address________________________________________________________________

Phone__________________FAX_______________Web address__________________

Designated representative________________________E-mail___________________

_____ $200 – Active member: Individuals and corporations and their branch offices and other entities who regularly engage in the distribution of seeds for planting within the State of Arizona, except retailers selling exclusively in packets, are eligible for active membership.

_____ $100 – Associate members: Individuals and corporations and their branch offices and other entities, within or without Arizona, who are in any way engaged or connected with the seed industry or its allied branches, excepting those qualifying for active membership, are eligible for associate membership.

_____ $25 – Research members: Individuals engaged in plant science research at any public institution in Arizona are eligible for research membership.

_____ $25 – Affiliate members: Individuals who wish to support the seed industry and to maintain an affiliation with Association members may belong as affiliate members. No one qualifying for active or associate membership is eligible for affiliate membership.

Describe the nature of the applicant’s business__________________________________

Authorize Signature______________________________Date______________________