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Membership Application

Name:______________________________ Company: ______________________________

Mailing Address:______________________________________________________________

City, State, Zip:_______________________________________________________________

Telephone:_____________________________ Fax:_________________________________

Correspondence E-Mail Address:________________________________________________

Press Release E-Mail Address:__________________________________________________

Website Address:_____________________________________________________________

Affiliation

Press – (Please enclose a copy of masthead, bylined article, or printout of same showing URL for online publications)

Publication(s):________________________________________________________________

Public/Media Relations – (Please enclose copy of press release listing applicant as contact person)

Products/Clients Represented:___________________________________________________

Membership Type
(Note: PR firms are encouraged to choose the Business or Corporate membership)

_____ Individual (Non-Transferable) - Available to anyone working in automotive communications $40.00/year

_____ Business (Transferable) - Covers one designated communications representative $100.00/year

_____ Corporate - Covers all communications personnel working for a company $500.00/year

Checks for membership dues should be made payable to: South East Automotive Media Organization and mailed along with this application and appropriate credentials to:

South East Automotive Media Organization
4429 Back Creek Church Road
Charlotte, NC 28213