Date of Birth
Licensed Issued in Which State
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By signing this Membership Enrollment Application, Member agrees to abide by the bylaws of ATDSA, as amended from time to time. Membership is effective immediately upon receipt of the membership dues and acceptance by ATDSA.
Members of ATDSA have access to certain benefits and/or products offered by ATDSA. Benefits and/or products are offered at the sole discretion of ATDSA and may vary by availability, vendor or the member’s state of residence. ATDSA may change vendors or immediately terminate the benefits and/or products offered in the event ATDSA’s vendor(s) terminate, cease, or modify such benefits and/or products. Termination of membership in ATDSA for failure to pay dues or for any other cause will result in the loss of such benefits and/or products.
Proxy: By signing this application I understand that I am enrolling as a member in ATDSA. I appoint the Secretary of ATDSA in office at any particular time as my proxy to receive notice of and attend all meetings of the members and vote on my behalf and to otherwise act for me in the same manner and with the same effect as if I were personally present. This proxy shall be valid until revoked at any time prior to voting at any meeting by executing and delivering a written notice of revocation to the Secretary of ATDSA, by executing and delivering a subsequently dated proxy to the Secretary of ATDSA or by voting in person.
Payment of Dues: The membership dues are $300 annually, unless otherwise set up on payroll deduction. Dues are due in full at the time of enrollment. You may cancel your membership at any time by sending a cancellation letter with your name and membership number to Member Services. Dues generally are not refundable but exceptions may be made on a case by case basis under guidelines determined solely at the discretion of ATDSA or as required by applicable law. I understand that the cost of this membership is my sole obligation. I further understand that I must be 18 years of age or older and be an individual professional truck driver as defined in the bylaws of ATDSA in order to be a member of ATDSA. I further understand that I am an independent contractor and nothing shall be construed as to create any employer-employee relationship between me and ATDSA.
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