National Association of State Motorcycle Safety Administrators

Individual Membership ApplicationAnnual Membership Dues:

Please choose Membership Category – Descriptions and Benefits listed on page 2____ Silver Individual Member: $25.00____ Gold Individual Member: $50.00

Name: _______________________________________Title: ___________________________

Street Address: ________________________________________________________________

City: _________________________________________________________________________

State: ________________________________________________________________________

Zip Code: _____________________________________________________________________

Phone: _______________________________________________________________________

Fax: __________________________________________________________________________

Email: ________________________________________________________________________

Providing your email address is very important as we communicate with our membership largely by email.

Print this form and mail with your check, payable to SMSA to:

SMSA Office1434 Trim Tree Road

Indiana, Pa. 15701Phone: 724-801-8075 Fax: 724-349-5042

Credit Cards can also be accepted by calling the SMSA office.

Membership Category Description Benefits Additional Benefits Annual

Dues

Silver Individual Member

Each applicant for Individual Member shall be an individual actively involved in supporting the reduction of injuries and fatalities associated with motorcycle crashes and promote responsible motorcycle operation.

The opportunity to shape the future of our profession by participating in SMSA programs and on SMSA committees.

The opportunity to network and share ideas through meetings and annual Symposiums.

Representation on the SMSA Executive Committee.

SMSA materials, including our Quarterly eMagazine, Special Reports, and Strategic Plan.

Member rates for conference registration.

Participation in SMSA Individual Webinars.

Use of the SMSA Proud Supporter logo.

Vote for representative to the SMSA Executive Committee

Access to the “Members Only” section on the SMSA website and membership contact directory.

$25

Gold Individual Member

Serve on SMSA Committees Opportunity to serve on the SMSA Executive

Committee Participate in SMSA Educational Webinars. Access to the SMSA Listserv

$50