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Company Name
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Street Address
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City
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State
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Zip Code
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Contact First Name
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Contact Last Name
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Phone
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Fax Number
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Emergency #
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Toll Free Number
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Email Address
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Web Site
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US Dot#
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Current Safety Raiting
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WUTC Authority #
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Excurision #
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# of Large Coaches
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# of Wheelchair Equipped Coaches
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Administrative
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Number of Mechanics
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Number of Drivers F/T
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Number of Drivers P/T
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Annual Dues for Motorcoach Operators
Are based on highest number of vehicles operated during the current year - Please check the one that applies to your company
Annual Dues for Affiliate Members
Are based on the number of employees - Please check the one that applies to your company
I will pay my dues by (select one)
If mailing check please send to Mary Presley, NWMA, PO Box 320266, Alexandria, VA 22320
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