2015 Retailer Member Application National Association of Wine Retailers 621 Capitol Mall, Suite 2500, Sacramento, CA 95814 Phone: (707) 266-1449 / Fax: (916) 442-0382 www.nawr.org Please complete by printing or typing all information: Organization: Name: Title: Address: City: State: Phone: ( ) Fax: ( ) Email: Web site: Zip Code: IMPORTANT: Please mark your organization’s preferred level of disclosure of its name as an NAWR Member: __ Public __ Semi-private (NAWR members, contributors and Board/Committee members only) __ Private (NAWR Board/Membership Committee members only) ORGANIZATION INFORMATION (please complete): Year Business Established: ____ Number of Locations: ____ In which US states does your organization have a presence? ____________________________________ How would you describe/categorize your organization? _________________________________________ MEMBERSHIP INFORMATION: Your organization is the member and each member organization is entitled to one (1) vote. RETAILER MEMBERSHIP DUES: There is a $1000 one-time initiation fee for new members plus monthly membership dues. The minimum monthly dues are $500. It is critically important that every member who can, contributes an additional “importance commitment” to this base level. This may be based on your annual revenue, your percentage of direct shipments and/or the importance of protecting current and/or opening up new direct shipping states for wine retailers. For example, on average NAWR members currently pay $1,000 per month which equals $500 in base dues + $500 in “importance commitment.” 2015 Dues Formula Initiation Fee Base Dues Commitment Dues Total Monthly Dues $ 1000 one time, plus $ 500 per mo ______ per mo (please fill in your additional “importance commitment”) ______ per month (please fill in your total monthly commitment) PAYMENT FREQUENCY (check one): Membership dues may be paid monthly, quarterly or annually based on the monthly dues amounts above. Invoice monthly Invoice quarterly Invoice annually OR Contribution Make checks payable to "National Association of Wine Retailers". Total Amount Enclosed (initiation fee + initial base dues + importance commitment OR contribution) $ ______ Please return completed application to NAWR at the above address. Pursuant to the 1993 Federal Tax Act, it is estimated that 0% of NAWR’s 2015 annual dues will be used to support NAWR’s 2015 direct lobbying efforts. Therefore, this portion of your NAWR 2015 dues may be considered non-deductible for tax purposes.
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