Section  III:  -  Association Dues
To assess you company's association dues, please use your most recently completed fiscal year to complete the following dues schedule.  All information provided to TRSA is kept strictly confidential.

Step 1: Calculate "ADJUSTED REVENUE" - Complete the steps below.
1-A. Total "Linen Supply and Industrial" Sales	>>> times 100% >>>	= $ (+)
1-B. Total "Commercial Laundry (COG/NOG)" Sales =$ times 75%		= $ (+)
1-C. "ADJUSTED REVENUE" volume that is the basis for Member's Dues		= $ (=)

Step 2: Select "STARTING BASE and VOLUME FACTOR"

Revenue Category	Revenue Range	Minimum Dues	Maximum Dues	Starting Base	Volume Factor
1	$0 to $499,999	$1,000	$1,000	ONLY enter "Maximum Dues" in Step #3-E
2	$500,000 to $999,999	$1,500	$1,500	ONLY enter "Maximum Dues" in Step #3-E
3	$1,000,000 to $1,499,999	$2,000	$2,000	ONLY enter "Maximum Dues" in Step #3-E
4	$1,500,000 to $17,999,999	$2,500	$18,340	$1,060	0.000 96
5	$18,000,000 to $69,999,999	$18,340	$27,700	$15,100	0.000 18
6	$70,000,000 to $569,999,999	$27,700	$62,700	$22,800	0.000 07
7	$570,000,000 and More	$62,700	$62,700	ONLY enter "Maximum Dues" in Step #3-E

2-A. Enter the "STARTING BASE" for Member's Revenue Range	= $
2-B. Enter the "VOLUME FACTOR" for Member's Revenue Range	= 0.000
Step 3: CALCULATE 2010 GROSS DUES
3-A. Copy the "ADJUSTED REVENUE" (Line #1-C)	$
3-B. Copy the "VOLUME FACTOR" (Line #2-B)	= 0.000
3-C. MULTIPLY (Line #3-A) times (Line #3-B)	$ = Amount over "Starting Base"
3-D. Copy the "STARTING BASE" (Line #2-A)	$ = "Starting Base"
3-E ADD: (Line #3-C) plus (Line #3-D) For Catagories #1 thru #3 and #7, enter "Maximum Dues"	$ = Gross Dues
Step 4: Discounts Members may take a discount for early payment or automated credit card payments. Please check the discount you wish to claim. For early payment discounts, payment must be received in the TRSA offices by Dec. 31, 2009; and for automatic credit card payments, a credit card number with expiration date and authorized signature must accompany this form.
4% Discount for full payment of 2010 Dues by check before Dec. 31, 2009 2% Discount for full payment of 2010 Dues by credit card before Dec. 31, 2009 1% Discount for automatic credit card payments
Step 5: Payment Indicate your 2010 TRSA Dues and method of payment below.
Please bill my dues:  (Please check one)

Annually	Quarterly		Semi-Annually
(Please check one)
Automatic Credit Card Payment Plan*		One-Time Credit Card Payment
Credit Card: (Please check one)
Visa	MasterCard		American Express

Card Number:
Expiration Date:
Name on Card:
* By agreeing to this option, TRSA will charge your quarterly payments on March 31, June 30 and Sept. 30 or your semi-annual payment on June 30.

2010 TRSA Dues (Line 3-E minus Discount)	$
Payment Enclosed or to Be Charged	$

TRSA dues are not deductible as a charitable contribution for federal income tax purposes.  However that may be deductible as a business expense subject to restrictions imposed as a result of association lobbying activities.

Section IV: Special First-Year Member Benefits
Each new member company is eligible for special first-year benefits. Please check the items you would like sent immediately:

	One FREE 2010 Roster/Buyers' Guide
	One FREE TRSA seminar registration, valid for one year form application date (not valid for MMI or PMI)
	One FREE TRSA publication*. Publication #
	Receive 10% off any other publications orders during 2010
Note: When registering for a free seminar or ordering a free or discounted publication, simply write "Free" or "10% Discount" on the form. * Excludes Washroom Test Kit, Chemicals, CD-ROMs and ProfitPoint™

Section V: Textile Rental Magazine
As a textile rental member of TRSA, your company is entitled to one free subscription for every $120 in paid dues to the association's award-winning magazine, Textile Rental. Please indicate below the names of other individuals from your company (in addition to those noted in Section II) that you would like to receive the magazine.

	Full Name	Formal Title	Mailing Address
1.
2.
3.
4.

Section VI: Digital Library Subscriptions
TRSA's Digital Subscription Library contains more than 130 publications, videos and computer media. The Library contains industry-specific resources on accounting, dust control, healthcare, production, sales and service and strategic management. Access to the Digital Subscription Library is available to members at no additional cost. Contact TRSA at 703/519-0029 for a passcode.

Section VII: TRSAPAC - TRSA's Political Action Committee

Company Name:
Name:
Title:
Company Address:
Company City:
Company State:
Company Zip:
E-mail Address:

		TRSAPAC is authorized to solicit voluntary contributions from myself only as a member of the executive and administrative personnel of my company for the following years.
	OR-
		TRSAPAC is authorized to solicit voluntary contributions from the executive and administrative personnel and stockholders of my company for the following years.

I understand that my company may not approve a solicitation by any other trade association for these years. (Federal law requires political committees to report the name, company, address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year.)

My company is a:

sole proprietorship

partnership

corporation

1. If your company is a sole proprietorship or a partnership, you need not sign the bottom portion of this prior approval form.

2. If you are the principal contact of a corporation, federal law requires you to sign the bottom portion of this prior approval form in order for the executive or administrative personnel of your corporation to be solicited. Based on the box marked above, this will give TRSAPAC permission to solicit voluntary contributions.

Please check below on each year that permission is granted to solicit and bill, based on the box marked above.

2010	2011	2012
2013	2014	2015

Section VIII: Committees
TRSA committees provide program and policy direction for the association. We encourage you or a representative from your company to participate on one of our committees.Your participation not only provides leadership for the association but also gives your company an opportunity to increase its industry visibility and build new relationships.

Would key company personnel be interested in serving on a TRSA committee?
Yes No Maybe - Tell me more.

Section IX: Referrals
If you were referred to TRSA by another member please let us know their name and company name.

Contact Name:

Company Name:

I swear and affirm that I have verified the information, including revenue and dues declarations, on this form is correct. (This box must be checked to complete this form)

Section IX: How to reach us
Please click on Apply to send this application electronically, or print then mail or fax this application with your dues payment to:

Textile Rental Services Association of America (TRSA)
1800 Diagonal Road, Suite 200, Alexandria, Virginia, 22314-2840

If you have any questions about the association or this application please contact us at:
Telephone: (703) 519-0029 • Toll Free: 877-770-9274 • Facsimile: (703) 519-0026