IATM

Application for Affiliate Membership

Name: ............................................................................................................................................

Address: ........................................................................................................................................

.................................................................. E-mail ……………………………………………

Phone: …………………………

Cell: …………………………...

Fax: ……………………………

Date of Birth: .............................................

Nationality: ............................................................

Mother Tongue: .........................................

Other Languages: ...................................................

.......................................................................................................................................................

This part to be completed if you have worked as a Tour Manager* for one season of less than 60 days:

Countries known intimately: ..........................................................................................................

I have worked from:

Date:........................

to Date: ................

For: ........................................................................

Date:........................

to Date: ................

For: ........................................................................

This part to be completed if you are a graduate of a nationally recognized Tour Management course:

Training Course Completed: ..........................................................................................................

Grades Achieved: ..........................................................................................................................

.......................................................................................................................................................

Certificate Gained (Yes or No): …………………

I enclose payment of US$80.00 for my 2011 membership

Signed: ..................................................................................................... Date: ………………….

Enclose 2 Passport-size photographs - signed on back

Mail completed application with photographs and fee to:

IATM Americas, 62 Baldwin Avenue, Point Lookout, NY 11569

For Office use only:

Date Received: ............................................................................... Amount Received: $ . . . . . . . .

Date Returned: ................................................................................. Membership # . . . . . . . . . . . .