Please print this application form,
complete, and send to: 

New England Livery Association
PO Box 842, Durham, NH  03824
Fax: 866.616.6352
E-mail: info@nelivery.org

For your security, please do not send this form via email with
your credit card information.

Need help? Call: 866-736-NELA (6352), or email: info@nelivery.com

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Application for NELA Affiliate Membership

To The Board of Directors, New England Livery Association:

I/We hereby apply for membership in the New England Livery
Association and any benefits that may derive therefrom.

I/We pledge to abide by the New England Livery Association
Principals of Professional Code of Ethics.

I certify that the information presented in this application is true and accurate.

Company Name: _________________________________________________

Contact Person: _____________________________________________________

Address: ___________________________________________________________

__________________________________________________________________

City : __________________________________

State: _________________________________ 

Zip Code: ______________________________

Phone Numbers - please include area codes:

Business: ___________________ Other: _____________________

Fax: ______________________ 

Email address (if applicable): ______________________________________________

Web Site (if applicable): _____________________________________ 

Business Category

Please select the most appropriate business type from the list below.

Vehicle Manufacturer:
Coach Builder:
Vehicle Dealer:
Vehicle Parts/Supplies:
Advertising/Marketing:
Uniforms:
Consulting:
Communications:
Trade Publications:
Legal/Accounting:
Hotel:
Insurance:
Computer Software:
Other:

Why do you want to join NELA?
______________________________________________

___________________________________________________

___________________________________________________

How can NELA beneft by having your company as a member?
______________________________________________

___________________________________________________

___________________________________________________
	

Membership Schedule

Membership dues and contributions are based upon number of company employees.

Total number of employees:

__ $175.00/year 5 or less employees
__ $300.00/year 6 or more employees

Total # of employees for which this application is submitted:

___________________

Dues payable: $_____________

Our check is enclosed for $______________

or Charge to (check one):

__ Mastercard

__ VISA

__ American Express

__ Discover 

Card#: __________________________________________

Expiry Date (mo/yr): _______________________________________

Your credit card will not be charged until your application is accepted. 
Membership dues and contributions are tax deductible to the extent permitted by law.

Signature: ______________________________________________

Print Name: _____________________________________________


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On behalf of the Board of Directors, thank you for joining 
the New England Livery Association. 

Larry White, President