Host_Agency

Name/Title:
Agency Name:
Doing Business As:
Street Address:
City and State:
Zip Code and Country:
Telephone Contact:	Area Code Number
Fax:	Area Code Number
Primary Email Address For Communication:
Email Address for Web Page:
Website Address:

Check any of the following that apply: ARC IATAN CLIA
ARC Number IATA Number
CLIA Number

Please Complete the following as they apply to your business.

We carry Errors & Omissions Insurance Amount
I require all of the independents to carry their own policy.
Are you a Registered Seller of Travel in your state, if required?
Registration Number if applicable.
Approximate Agency Total Annual Sales Yearly
Average Annual Sales per Independent
Current Number of Independents
How long have you been working with independent agents?
How many years has the agency been in business?

Dues Calculation

Host Level: $395 (395 renewal annually)

Payment Information
Please accept my NACTA Membership Application.
I will make payment by Check Credit Card

Credit Card Type
Credit Card Number
Expiration Date
Name as it appears on Credit Card

If paying by check, submit this form and follow with your check my mail to:
NACTA, Inc.
1101 King Street, Suite 200
Alexandria, VA 22314

*This NACTA membership is valid for one year from the date noted above. NACTA Host membership price is $395 for Host Level & $395 to renew annually.
Membership fees are non-refundable. The National Association of Commissioned Travel Agents neither guarantees
nor insures that the service provided any officer, employee or member and shall assume no responsibility or liability
for actions or events beyond its control in connection with services provided. Further members agree to hold NACTA
harmless for any act, error, omission, injury, loss, accident, nonperformance, financial failure, or any other irregularity,
or any consequences resulting there from, which may be caused from the neglect, default, or any other action of
association, company, carrier, independent contractor or person engaged in the service of NACTA