MEMBERSHIP APPLICATION RETREAD TIRE ASSOCIATION (RTA)

Your Name: Company Name: Address: City: Country: E-Mail: State/Province: Phone: Website: Zip/Postal Code: Fax:

ANNUAL MEMBERSHIP DUES
RETREADERS TIRE DEALERS SUPPLIERS CASING DEALERS TIRE & TRUCKING INDUSTRY MAGAZINES INDIVIDUAL MEMBERSHIP OTHERS ASSOCIATIONS NEW TIRE MANUFACTURERS TRUCKING COMPANIES RECYCLING ORGANIZATIONS 1 or 2 locations/retread plants 3 or more locations/retread plants 1 or 2 locations 3 or more locations $350 $175 $350 $175 $200 (Company Salespeople, Friends of RTA) (Attorneys, Consultants, Investment Companies, etc.) State/Regional National $150 $350 $350 Negotiated $1,000 $200 $350 Minimum Each Additional Location Minimum Each Additional Location

PLEASE CIRCLE ONE PRIMARY CATEGORY:

RETREADER MAGAZINE SUPPLIER CASING DEALER TRUCKING COMPANY TIRE DEALER INDIVIDUAL OTHER

NEW TIRE MFR

RECYCLING ASSN

PAYMENT METHOD:
___ CHECK IN THE AMOUNT OF $__________ (IN U.S. DOLLARS) PAYABLE TO: RTA ___ VISA ___ MASTERCARD ___ AMERICAN EXPRESS EXP DATE: ____________

CREDIT CARD NUMBER: ___________________________________________________ CVV2 (SECURITY CODE): ____________

CARDHOLDER NAME AS PRINTED ON CARD (Please Print): _________________________________________________ CARDHOLDER SIGNATURE: ____________________________________ RTA has my authorization to charge $______________ to my credit card.

*PLEASE COMPLETE BOTH SIDES OF THIS APPLICATION.

TO HELP US MAXIMIZE YOUR MEMBERSHIP BENEFITS, PLEASE FURNISH THE FOLLOWING INFORMATION: ____ Yes! You may use our company name on the RTA website as a new member, and you may publicize our company name in the news releases to the tire media. ____ No, we prefer to remain anonymous. Do not publish our company name. Please let us have your input on the three most important issues you would like to see RTA work on in the immediate future. 1. 2. 3. Please list any additional email addresses you wish to have us add for RTA News Releases, Memos and Member Newsletters. You may add as many as you wish.

We wish to receive the following RTA Memos on a regular basis: ____ Casing Memos ____ Supplier Memos ____ Want-To-Export Retread Memos

____ Yes! We would be interested in having Harvey or another RTA representative attend an open house or other type of meeting at our location. (RTA will contact you to discuss dates and other details.) PLEASE CIRCLE ALL APPLICABLE. We retread the following: PASSENGER We use: MOLD CURE PRE CURE RINGTREAD UNICIRCLE ____ NO LT TRUCK MED TRUCK SMALL OTR LARGE OTR INDUSTRIAL FARM

We are a bead-to-bead retreader? ____ YES

Number of retread plants we operate? _______ (This information is required for billing purposes if you have more than two retread plants. To buy or sell casings or new/used equipment or machinery, just send RTA an email (info@retreadtire.org) with the details of what you wish to buy or sell. You can also call our toll-free number 888-810-8861 and well be happy to take the information over the phone. *Please complete BOTH SIDES and return with your payment to:

Retread Tire Association 900 Weldon Grove Pacific Grove, CA 93950 USA Or Fax to (831) 646-2006
Thank you and welcome to the RTA family! Harvey Brodsky, Managing Director (831) 646-5269