Contact Name:             
Title:                    
Brand Name:        
Franchisee Association Name:    
Mailing Address:   
City:          St: Zip:
Telephone: Fax:
E-mail:      

Independent Franchisee Associations pay $25 per outlet (minimum contribution applies).
Number of Outlets: Amount enclosed $

We hereby apply for membership in the American Franchisee Association (AFA). When accepted, we will be entitled to all membership privileges and services and will support AFA's Activities. We understand that our twelve-month membership begins when AFA receives our dues.

Anonymous Designation: AFA keeps all membership confidential. However, if you indicate "Anonymous" we will designate your association membership in a special category "Anonymous-neither your association name nor the brand name of the frachise you represent will be disclosed at any time.

Check enclosed (payable to AFA)

Please charge my: AMEX    VISA   MC   Card Number:
Expiration Date:    Signature of Cardholder (required): ________________________________

After this form is filled out Print to Fax (charge only) or Mail Today.