Our Company is a rural Independent local exchange carrier under 100,000 access lines considering or currently providing competitive telecommunications services.

Our company is a rural independent competitive telecommunications services provider owned or operated by an incumbent local exchange carrier under 100,000 access lines.

Dues Structure

Voting Member:
$1,500 first year
$3,000 each year thereafter
(pro-rated quarterly)

Affiliate Member:
$1,200 first year
$2,400 each year thereafter
(pro-rated quarterly)

VOTING MEMBER INFORMATION	Please fill out this section of the form if you are applying for Voting Membership.(1-13)
1. Company Name
2. Address
3. City
4. State
5. Zip
6. Phone
7. Fax
8. Contact Name
9. Title
10. Phone Number
11. Email
12. Web Address
13. # Access lines served

AFFILIATE MEMBER INFORMATION	Please fill out this section of the form if you are applying for Affiliate Membership. (14-29)
14. Company Name
15. Address
16. City
17. State
18. Zip
19. Phone
20. Fax
21. Contact Name
22. Title
23. Phone Number
24. Email
25. Web Address
26. % Ownership by Rural LEC
27. # access lines served by Rural ILEC
28. # Access lines your company serves
29. Our company offers the following competitive services: Voice Data Broadband Video None at this time Other:

Method of Payment

Visa	MasterCard
AMEX	Discover
Card #
Exp. Date
Name on Card
Amount Paid:
Membership Fee
TOTAL