Contact Information (information printed as you wish it to appear on your badge):

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

Committee Participation (check all that apply):

Certification & Ethics
Publications
Awards
Conference
Strategic Planning
Board of Directors

Fees (check one):

TFA Member (prior to 3/20) = $0 TFA Member (post 3/20) = $35 Nonmember (before 3/20) = $100 Nonmember (post 3/20) = $135