Legal Company Name(Required)

Name of Parent Company that is a Full Paid Carrier Member with AMTA(Required)

Company Trade Name

Company Email(Required)

Company Phone Number(Required)

Company Address(Required)

Address Line 2

City(Required)

Province / State / Region(Required)

ZIP / Postal Code(Required)

Country(Required)

What is the primary reason for becoming an AMTA Carrier Member?(Required)

Safety (AMTA expertise and resources)

AMTA education and training discounts

COR/SECOR (To obtain COR/SECOR)

To obtain an AMTA Certified Transportation Safety Professional (CTSP) or Certified Transportation Safety Coordinator (CTSC) certificate

Carrier Member Network online platform to network with other Carriers and AMTA staff

Compliance and Regulator Affairs (CRA) meetings and updates

Membership pricing at AMTA events

Sponsoring AMTA events

Applicants First Name(Required)

Applicants Last Name(Required)

Applicants Job Title

Applicants Email(Required)

Applicants Phone Number(Required)

Total Number of NSC Trucks(Required)

Total Number of Trailers(Required)

Total Number of Class 1 Professional Drivers(Required)

Total Number of Class 2 Professional Drivers(Required)

Total Number of Class 3 Professional Drivers(Required)

Accounting Contacts First Name(Required)

Accounting Contacts Last Name(Required)

Job Title

Accounting Contact Email(Required)

Accounting Contact Phone Number(Required)

AMTA offers a Membership Referral discount to current paid AMTA members. Were you referred by a current AMTA Member?

Referral Contacts First Name

Referral Contacts Last Name

Referral Email(Required)

Referral Phone Number(Required)

Subsidiary Membership