WRAPP MEMBERSHIP FORM WRAPP memberships run according to the calendar year, January 1 thru December 31. Membership will commence/continue upon receipt of this form and membership fees. Any membership form received during the last two months of the year will make you a member for the remaining two months of that year thru December 31 of the following year. We have three different membership levels. It is our hope that this system will offer our ever increasingly diverse members an option that will best suit their particular needs. The membership levels are as follows: Individual $25.00 This level is for an agency that provides some para-transit service and has need for only one staff person to be a WRAPP member. That member will have voting rights and will be offered any other benefits and rate reductions offered under a WRAPP membership. Agency $50.00 This level is available for an agency that has more that one staff person that would benefit from a WRAPP membership. The agency has one vote and must designate one staff member as their voting delegate. That delegate and all other staff listed under the WRAPP agency membership will be offered all other benefits and discounts allowed WRAPP members. Associate $20.00 This level is available for any individual that has an interest in para-transit issues in Wisconsin. This individual wishes to show their support of our organization but has no interest in becoming a voting member. That member will be offered all other benefits and discounts allowed WRAPP members. Make your check payable to Wisconsin Rural and Paratransit Providers and mail it with the following completed form to:     Rita Harmon, Treasurer Grant County Center on Aging Box 383 Lancaster WI 53813 If you are registering under an Agency membership please use this side of the form to list your voting delegate and use the back of the form to list each additional individual that will be included under the agency membership. If you are registering as an individual or patron please complete just the front portion of this form. Type of membership wanted: (please check one)    Individual      Agency      Associate Name:    _________________________________ Title: _____________________ Date: ____ /____ /____ Address: _________________________________________________________________________________              _________________________________________________________________________________ City:       ________________________________ State: ___________________ Zip: ___________________ Phone:    ______________________________________ Fax: _____________________________________ Email:     _________________________________________________________________________________ County in which you work: ______________________ (Associate members do not have to list county) Addition listings under agency membership: If you need more blanks make copies of this form. Name:    _________________________________ Title: _____________________ Date: ____ /____ /____ Address: __________________________________________________________________________________              __________________________________________________________________________________ City:       ________________________________ State: ___________________ Zip: ___________________ Phone:    ______________________________________ Fax: ______________________________________ Email:     _________________________________________________________________________________ Name:    _________________________________ Title: _____________________ Date: ____ /____ /____ Address: __________________________________________________________________________________              __________________________________________________________________________________ City:       ________________________________ State: ___________________ Zip: ___________________ Phone:    ______________________________________ Fax: ______________________________________ Email:     _________________________________________________________________________________ Name:    _________________________________ Title: _____________________ Date: ____ /____ /____ Address: __________________________________________________________________________________              __________________________________________________________________________________ City:       ________________________________ State: ___________________ Zip: ___________________ Phone:    ______________________________________ Fax: ______________________________________ Email:     _________________________________________________________________________________ Name:    _________________________________ Title: _____________________ Date: ____ /____ /____ Address: __________________________________________________________________________________              __________________________________________________________________________________ City:       ________________________________ State: ___________________ Zip: ___________________ Phone:    ______________________________________ Fax: ______________________________________ Email:     _________________________________________________________________________________