Service Provider Application

Service Provider Membership

Membership Selection *

Service Provider – $ 6,500.00: Renews at $5,000 annually

Total Amount

Service Provider Membership Application

To ensure your application submits correctly, please avoid pasting any text with formatting (such as bold, italics, or special fonts). We recommend copying text only from plain text documents like Notepad, which removes any unwanted formatting.

General Information

Company Name *

Company Email *

Street Address *

City *

State *

Postal Code *

Phone *

Company Website

Select the category that best fits your business

Description of products or services you would like to promote in the Association

How does your product or service specifically target/benefit Program Administrators?

What differentiates your product from others in the marketplace?

How many clients do you currently have?

What are the top three benefits you would expect to derive from your first full year of membership?

Highlight your services to be displayed on the Service Provider list page of the TM website (max 100 characters)

Services

Disclosures

Are you and/or the company a plaintiff in any current or soon to be filed suits?

Yes No

Plaintiff: If yes, please explain

Are you and/or the company aware that you may be a defendant in any pending litigation?

Yes No

Defendant: If yes, please explain

References

Please provide the names of three program administrators or carriers that have utilized your product or service that we may contact for a reference. We prefer references from TMPAA members.

Reference 1: Name *

Reference 1: Company *

Reference 1: Phone *

Reference 1: Email *

Reference 2: Name *

Reference 2: Company *

Reference 2: Phone *

Reference 2: Email *

Reference 3: Name *

Reference 3: Company *

Reference 3: Phone *

Reference 3: Email *

Please note: One recommendation letter from a program administrator or carrier you've worked with is required before we can process this application. References from existing TMPAA members are preferred. Email to krista.hardy@targetmkts.com.

I understand that the application must be favorably considered by the membership committee before the applicant can participate in the Association. An invoice for the non-refundable membership fee will be sent after approval. Meeting registration and Trade Show fees are not included in membership dues. NOTE: Trade Show tables are limited and not a guarantee of membership.

By submitting this application:

The applicant attests that all information in the application is correct.
The applicant will abide by the Association Bylaws and TMPAA Code of Conduct.
The applicant is not aware of any reason why the Bylaws cannot be observed.
The applicant agrees to comply with the Service Provider Solicitation Policy.

Service Provider Attestation *

Agree

Account

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Primary Contact

First Name *

Last Name *

Phone *

Email *

Payment Options

[x] Payment due upon approval.

Additional Individuals Actively Participating in the Association

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