Application for Membership in the ITCA
First Name:
Last Name:
Title:
Employer:
Mailing Address:
City:
State (if in US):
State/Province (if outside US):
Zip/Country Code:
Country:
Telephone Number: - -
Fax Number:
E-Mail Address:
Website Address:
Brief Description of Your Organization/Responsibilities:
Organization Type:
Employer: For-Profit Company  Government  Non-Profit 

Educational Institution: Elementary  Middle  Secondary  2-Year  4-Year 

Public or Private: Public  Private 
Membership Type: Renewal  New 

Please check: Regular  Honorary (Not a certified Facilitator or Trainer)  Retired  Honorary Lifetime  Affiliate (Training completed but not yet Certified) 
What is your Color Schema?
1.
2.
3.
4.
Person referring you to The True Colors Association:
What Level of Certification do you have: BAS Facilitator  Advanced App Facilitator  BAS Trainer  Advanced App Trainer  Master Trainer  no certification 
How long have you been a True Colors Facilitator or Trainer? Since / (month/year)
Are you interested in serving as a Mentor for a new member? (Level 4 and above only) Yes  No  Maybe (Please contact me with more information.) 
ORGANIZATIONAL MEMBERSHIP DUES:
Memberhsip Year: November 1 - October 31 membership year TAX ID# 20-3689533
$35.00 (1 member) 
$100.00 (for up to 4 members; $25 each additional member)
** Please submit an Application for each additional member so we will have contact information for all members.
Number of organizational memberships covered by this payment:
Name of organization:
TOTAL DUE to The True Colors Association:  
$
Check enclosed 
Purchase order/check in progress (Organizational Memberships only)
PLEASE SEND PAYMENT TO:
True Colors Association PO BOX 992
Bellevue, WA 98009-0992

** PLEASE MAKE CHECKS PAYABLE TO THE TRUE COLORS ASSOCIATION. **
If you would prefer, you can pay your membership through PAYPAL. If you have a paypal account, you can go to www.paypal.com and make a payment using the ITCA paypal email address: membershippayment@truecolorsassociation.org. This will allow you to pay your $35 fee online directly out of your checking or savings account or with a credit card, depending on how you have set up your personal paypal account.