Yes, I which to receive a free NGA membership certificate.

III.  CHOOSE NGA MAGAZINE

Yes, I wish to receive Glass Magazine AND/OR Yes, I wish to receive AutoGlass

  Glass Magazine  (You must complete this information entirely to process your subscription.)
 1. What is your company's primary business? (Check only one)

A. Dealer/Retailer of Glass, Metals and/or Related Products
B. Contract Glazing Company/Glazing Subcontractor of Glass, Metals and/or Related Products
C. Distributor/Wholesaler of Glass, Metals and/or Related Products
G. Manufacturer/Fabricator of Completed or Assembled Products and/or Systems
H. Supplier of Glass, Metals, Components, and/or Related Products
E. Architect/Specifier, Commercial Builder, Residential Builder or Non-Glass Specific Contractor
F. Others Allied to the Field only as Trade Association Executives, Technical Consultants or Testing Labs. Please specify:

 Glass Magazine
 2. What is the Principal's primary job function? (Check only one)

M. Management/Ownership
P. Purchasing
I. Installation
S. Sales
A. Architecture/Specification
O. Other (Please specify): 

 AutoGlass (You must complete this information entirely to process your subscription.)
 1.What is your company's primary business? (Check only one)

1. Dealer/Retailer of auto glass and/or related products (replacement/repair)
2. Distributor/wholesaler of auto glass and/or related products
3. Manufacturer/fabricator of glass products for OEM
4. Manufacturer/fabricator of glass products for AGR
5. Manufacturer/fabricator of glass products for OEM and AGR
6. Manufacturer/fabricator of non-glass products for OEM
7. Manufacturer/fabricator of non-glass products for AGR
8. Manufacturer/fabricator of non-glass products for OEM and AGR
9. Automotive body repair shop
10. Car dealership
11. Insurance company
12. Other (Please specify): 

 AutoGlass
 2. What is the Principal's primary job function? (Check only one)

M. Management/Ownership
P. Purchasing
S. Sales
I. Installation
O. Other (Please specify):

Check here if you want to receive a sample copy and subscription form for Window & Door:
Yes, please send me information on NGA's publication Window & Door.

* In lieu of a signuature, in what month were you born?  Select one January February March April May June July August Septemeber October November December

IV.  CALCULATE YOUR COMPANY'S DUES

Dues are based on your company's gross annual sales in glass and glass-related products, plus all the additional locations in the United States, Canada or Mexico, which the company owns. Members are required to pay the highest dues for which they qualify.

Gross Annual Sales	Base Dues*
Under $ 1 million	$ 300
$ 1 to $ 2 million	$ 540
$ 2 to $ 3 million	$ 780
$ 3 to $ 5 million	$ 1,055
$ 5 to $ 10 million	$ 1,435
$ 10 to $ 20 million	$ 2,135
$ 20 to $ 49 million	$ 2,975
Over $50+ million	$ 4,755

$	Base dues (see chart above)
$	Additional location fee: $20 per United States location
$	International Surcharge: $25 (for companies outside United States only)
$	Total Dues

*A complete listing of all additional locations must accompany this application.

 Contributions—Thank you for your support!
 Additional contribution to the Coalition for Auto Glass Safety & Public Awareness (CASPA). $100 $200  $500 $1,000
Other (Please specify): 
CASPA's mission is to promote public understanding of auto glass as a crucial safety component in the modern vehicle's safety restraint system, and, to assist consumers in locating safe auto glass replacement in the aftermarket.

 V.  PAYMENT

NOTE: To complete online registration, credit card is the only form of payment accepted. After filling out the form, click on the submit button and your information will be submitted by way of our secure web server. Payment must be received before membership is accepted.

 $  Total Payment

To pay by check: (Made payable to NGA) Press Ctrl-P or File-Print to print out this page on your local printer and mail to NGA with payment (NGA, 8200 Greensboro Dr., Ste 302, McLean, VA 22102, USA). Note: No need to press the "Submit" button if mailing in the form. Non-United States organizations must make payment with a credit card or a draft on a U.S. bank. This draft can be purchased at a bank in your area.
 
Type of Card:  Visa  MC  AMEX

Card Number
Expiration Date
Name on the Card

 VI.  READ CODE OF ETHICS

By joining NGA, your company agrees to abide by NGA's Code of Ethics. To promote and encourage fair and ethical competition To fulfill all contractual obligations and respect the contractual obligations of others by not inducing breach of existing contracts To use safety glazing materials whenever possible and to refuse to sell unsafe products To maintain a safe work area which provides adequate inventories of glass products and to sell these products at a fair and non-discriminating price To maintain the highest industry-wide standards of professional and personal conduct To promote the advancement of the association on both the local and national levels, supporting its goals and objectives. Adherence to this code of ethics serves to assure public confidence in the integrity and service of NGA member glass professionals everywhere.

I certify that my company's dues category and location information are correct. I understand that my company's business type and dues category will appear in the NGA Membership Directory as shown above. Press the "Submit" button after reading and agreeing with the above. Notice: Member dues may be deductible as ordinary and necessary business expenses. Consult your tax advisor for details.

 QUESTIONS?
 Call us at 1-866-DIAL NGA (342-5642), ext. 151

 Who encouraged you to join? (if applicable)

Person's Name
Their Company Name
Address
City/State/ZIP

Signature (Please type full name)