TENNESSEE FIREWORKS ASSOCIATION
MEMBERSHIP APPLICATION FORM
Mail to: TFA, P. O. Box 1628, Lavergne, TN 37086

If membership renewal has no address/phone changes, complete only Part I, if changes, complete Parts I and II; new membership applicants complete Part II.

Use second sheet if necessary.  Membership Code:  Individual (I), Corporate (C), Vendor (V), or Associate (A)

Part I Renewals

Name ________________________ Code ___   Name ________________________  Code ___  Date ______________

Name ________________________ Code ___   Name ________________________  Code ___

Name ________________________ Code ___   Name ________________________  Code ___

If also company membership, name of company: ______________________________

Part II New Memberships

Name ________________________  Code ___  Address  _______________________ Date _____________

City __________________ State______ Zip _________ Phone ___________ Cell ____________

Email  ______________________________ If also company membership, name of company:

 __________________________ Company address: __________________________

City ___________State ______ Zip __________ Phone ________________________

Name ________________________ Code ___ Address  _______________________ Date _____________

City _____________ State______ Zip _________ Phone ___________ Cell ____________

Email  ______________________________ If also company membership, name of company:

 _________________________ Company address: ___________________________

City ___________State ______ Zip __________ Phone ___________

Total amount of dues:  $ _________________.

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