AMOA LOGO
600 Spring Hill Ring Road, Suite 111, West Dundee, IL 60118
Tel: 847-428-7699 * Fax: 847-428-7719 * Toll Free: 1-800-937-2662

2012 MEMBERSHIP APPLICATION
All fields marked with a * are required:
Company*
First Name*
Last Name*
Address*
City*
Country*
State / Province
Zip / Post Code*
Telephone*
Fax
Website
eMail*
Business Type*
MEMBER CLASSIFICATION See Note Below!
Operator membership dues are based on # of full-time employees; please include owners. (2 part-time employees = 1 full-time employee)
Maximum dues = $1580.00. Select the number of employees and appropriate fees.
EXPO Complimentary badges equal number of employees as indicated above.
Member Type*
SubCategory*
PAYMENT INFORMATION
Payment Type*
Credit Card Number*
Expiration Date*
Security Code
Name on Card*
TYPES OF LOCATIONS (Check All That Apply)
 Amusement Arcades  Street Locations  Amusement Parks
 Family Entertainment Centers  Bars or Restaurants  Food Vending or Concessions
 Miniature Golf Locations  Bowling Centers  Other Types of Locations

TYPES OF PRODUCTS (Check All That Apply)
 Jukeboxes  Pinball Games  Cigarette Vending
 Video Games  Redemption  Kiddie Rides
 Bulk Vending  Payphones  Legalized Gaming
 Food Vending or Confections  Soft Play Equipment  Foosball Air Hockey
 Electronic Darts  Pool or Billiards  Virtual Reality Games
 ATMs  Security Systems  Photo Booths
 Other Equipment


NOTE: ALL DUES AMOUNTS INCLUDE A VOLUNTARY $25.00 TAX DEDUCTIBLE CONTRIBUTION TO THE AMOA COIN-OP CARES EDUCATION & CHARITABLE FOUNDATION. If you do not wish to contribute, please check the box below to deduct $25 from the Total Due above. It is estimated that 25% of your 2012 membership dues will be non-deductible due to lobbying expenses as a result of the Omnibus Budget Reconciliation Act of 1993. All Dues are good for Calendar Year.
Check here if you DO NOT wish to contribute 

By clicking the SUBMIT button below, I hereby give AMOA authorization to charge my credit card (as indicated above) for the total amount due as shown below: