County Membership Application Contact Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Phone(Required)Email Website FaxCounty Level(Required) Counties collecting < $20,000 in Total Lodging Tax per Year - $200 Counties collecting $20,001 - $50,000 in Total Lodging Tax per Year - $400 Counties collecting $50,001 - $100,000 in Total Lodging Tax per Year - $600 Counties collecting > $100,001 in Total Lodging Tax per Year - $800 Credit Card Processing Fee Price: $0.00 This field is hidden when viewing the formCredit Card Fee (Display)Total Includes credit card processing fee of $0.30.Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
