Membership Application

Please complete the form and click on one of the Send buttons to select a payment method.

* Indicates required fields

*DUES

Please check appropriate dues category. See below for Membership Type descriptions.

Sales Volume Annual Membership Fee Voting - Gross Yearly Sales Up to $350,000 $190.00 Voting - Sales from $350,000 to $500,000 $270.00 Voting - Sales from $500,000 to $1 million $360.00 Voting - Sales from $1 million to $3 million $500.00 Voting - Sales from $3 million to $5 million $600.00 Voting - Sales from $5 million to $10 million $790.00 Voting - Sales over $10 million $1,100.00 International $220.00 Affiliate $300.00

VOTING MEMBERS

Proprietors of single stores and owners of local and regional retailing corporations. Voting Members receive all NSRA member mailings, benefits and discounts and may serve on the association's task forces, committees and Board of Directors. Annual dues for Voting Members are based on total sales volume in the previous fiscal year.

INTERNATIONAL MEMBERS

Retailers outside the United States and Canada. International Members have same rights and privileges as Voting Members.

AFFILIATE MEMBERS

Manufacturers, wholesalers, suppliers, shoe travelers and other non-retailers. Affiliate Members receive all member mailings, member discounts, and special advertising and exhibit rates for NSRA publications and conferences; and may serve on Association task forces and committees.

GENERAL INFO
*Prefix:		*Street Address:
*First Name:		*City:
*Last Name:		*State:
Title:		*Postal/Zip Code:
Company:		*Telephone:
*E-Mail:		Fax:
Home Page URL:

SECONDARY CONTACT
Prefix:		Title:
Last Name:		First Name:

ADDITIONAL EXECUTIVES
Executive employees of Voting, Affiliate and International Members. Additional Execs receive all NSRA mailings and discounts and may serve on Association task forces and committees. Annual membership dues $35.00 for each added executive.
Prefix:	First Name:	Last Name:
Prefix:	First Name:	Last Name:
Prefix:	First Name:	Last Name:
Prefix:	First Name:	Last Name:

BRANCH STORE MEMBERS
Branch stores of Voting and International Members. Branch Store Members receive all NSRA mailings and discounts, participate in member benefits programs like Credit/Debit Card and Check Guarantee at no additional cost, and may serve on Association task forces and committees. Annual membership dues $35.00 for each location.
Prefix:		Street Address:
First Name:		City:
Last Name:		State:
Title:		Postal/Zip Code:
Company:		Telephone:
E-Mail:		Fax:
Home Page URL:
Second Branch
Prefix:		Street Address:
First Name:		City:
Last Name:		State:
Title:		Postal/Zip Code:
Company:		Telephone:
E-Mail:		Fax:
Home Page URL:

BACKGROUND
To help us meet your needs, please complete the following information.
Type of Operation (check all that apply):	Location (check all that apply):	Number of locations
Independent Shoe Store Leased Department Mail-order Business Apparel Store with Shoe Section Department Store National Shoe Chain Other	Downtown Commercial Area Enclosed Mall Strip Center Free-standing
Gender of Footwear (check all that apply):	Categories of Footwear (check all that apply):
Men's Women's Children's	Athletic Casual Clogs Custom Dance Dress Outdoor Orthopedic/Pedorhtic Safety/Work Service Slippers Western
Retail Price Points (check all that apply):	Special Sizes and Widths:
Low to moderate (up to $40) Moderate ($41 - $90) Moderate to high ($91 - $150) Over $150

NEW MEMBER REQUESTS
Please send me details on the following NSRA programs that I, as a member, can put to use immediately.
Credit/Debit Card Processing Check Verification and Guarantee Store Design Consulting Lease Consulting FedEx Ground Shipping Discounts The Learning Center Business Consulting	Yellow Freight Discounts Gift Card Program POS Information Merchandise Planning & Inventory Management Health, Business, Auto and Life Insurance WISER Sales Training DVD
Please send me the following publication(s) at the member-discount price. 2006/7 Business Performance Report - ($100; member price $50)

METHOD OF PAYMENT

Note: Secure Online Payment is available. Credit Card payments can also be made by calling 1-800-673-8446 or faxing to 1-410-381-1167. If you prefer to pay by check, please print out this form and mail with your check to: National Shoe Retailers Association 7150 Columbia Gateway Drive, Suite G Columbia, MD 21046 *Credit Card Type: MC VISA OTHER *Card Number: *Exp Date *Name on card: *Amount: