Membership Application Membership ApplicationCompany informationOrganization’s nameMain RepresentativeRepresentative titleAddressState- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCity- Select -AdjuntasAguadaAguadillaAguas BuenasAibonitoAreciboArroyoAñascoBarcelonetaBarranquitasBayamónCabo RojoCaguasCamuyCanóvanasCarolinaCatañoCayeyCeibaCialesCidraCoamoComeríoCorozalCulebraDoradoFajardoFloridaGuayamaGuayanillaGuaynaboGuraboGuánicaHatilloHormiguerosHumacaoIsabelaJayuyaJuana DíazJuncosLajasLaresLas MaríasLas PiedrasLoizaLuquilloManatíMaricaoMaunaboMayagüezMocaMorovisNaguaboNaranjitoOrocovisPatillasPeñuelasPonceQuebradillasRincónRio GrandeSabana GrandeSalinasSan GermánSan JuanSan LorenzoSan SebastiánSanta IsabelToa AltaToa BajaTrujillo AltoUtuadoVega AltaVega BajaViequesVillalbaYabucoaYaucootherZip CodeCompany physical addressState- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCity- Select -AdjuntasAguadaAguadillaAguas BuenasAibonitoAreciboArroyoAñascoBarcelonetaBarranquitasBayamónCabo RojoCaguasCamuyCanóvanasCarolinaCatañoCayeyCeibaCialesCidraCoamoComeríoCorozalCulebraDoradoFajardoFloridaGuayamaGuayanillaGuaynaboGuraboGuánicaHatilloHormiguerosHumacaoIsabelaJayuyaJuana DíazJuncosLajasLaresLas MaríasLas PiedrasLoizaLuquilloManatíMaricaoMaunaboMayagüezMocaMorovisNaguaboNaranjitoOrocovisPatillasPeñuelasPonceQuebradillasRincónRio GrandeSabana GrandeSalinasSan GermánSan JuanSan LorenzoSan SebastiánSanta IsabelToa AltaToa BajaTrujillo AltoUtuadoVega AltaVega BajaViequesVillalbaYabucoaYaucootherZip CodePhone numberMobile numberEmail addressExtension numberFax NumberWebsiteMembership and applicable annual fee- Select -VOTING MEMBER (operating company)JUNIOR CHAPTER MEMBERTELECOMMUNICATIONS INFRASTRUCTURE MEMBERVENDOR MEMBERAFFILIATE MEMBERDesplegable-Miembro Votante- Select -More than $100 million in annual revenueMore than $10 million in annual revenueBetween $5 million to $10 million in annual revenueBetween $1 million to $5 million in annual revenueDesplegable- Associate Member- Select -Tower Co.OtherDesplegable-Junior Chapter Member- Select -An annual revenue below $1,000,000.0Desplegable - comapnia torres- Select -Company with 21 or more towersCompany with 20 towers or lessAnnual fee $40,000Annual fee $8,000Annual fee $6,000Annual fee $3,000Annual fee $7,500 (voting right)Annual fee $3,000Annual fee $3,000Annual fee $3,000Annual fee $3,000Annual fee $500Annual fee $1,000NameTitleCompanyAPT’s fiscal year and membership runs from January 1 st to December 31 st of each year. PAYMENT INFORMATION: Payment must be issued in dollars, via check payable to Alianza Puertorriqueña de Telecomunicaciones. Send check payment by regular mail to: Membresías APT, P.O. Box 11345, San Juan, PR 00922-1345 Your APT membership will become effective when the Board of Directors and the Membership Committee approve your application.Alternative RepresentativeTitlePhone NumberEmail AddressFax NumberCEO/President Contact InformationNameContact’s PhoneTitleContact’s emailContact information for state government affairsNameContact’s PhoneTitleContact’s emailBilling Contact InformationNameContact’s PhoneTitleContact’s emailLawyer Contact InformationNameContact’s PhoneTitleContact’s emailPublic Policy ContactNameContact’s PhoneTitleContact’s emailPublic Relations ContactNameContact’s PhoneTitleContact’s email# of Employees: 1 – 50 51 – 100 101 – 250 251 – 500 501 – 1,000 1,001 or moreServices provided Broadband Internet Dedicated Internet Voice Over IP (VOIP) IPTV Cable TV Satellite TV Satellite Internet Mobile Internet Telephone Services Mobile Telephone Services Data Transfer (Metro Ethernet, MPLS) Data Center Internet ExchangeBrief description of what the company doesSale or service Retail Commercial BothCoverage Area All the island Select towns / municipalitiesSeleccione Pueblo / Municipio Adjuntas Aguada Aguadilla Aguas Buenas Aibonito Arecibo Arroyo Añasco Barceloneta Barranquitas Bayamón Cabo Rojo Caguas Camuy Canóvanas Carolina Cataño Cayey Ceiba Ciales Cidra Coamo Comerío Corozal Culebra Dorado Fajardo Florida Guayama Guayanilla Guaynabo Gurabo Guánica Hatillo Hormigueros Humacao Isabela Jayuya Juana Díaz Juncos Lajas Lares Las Marías Las Piedras Loiza Luquillo Manatí Maricao Maunabo Mayagüez Moca Morovis Naguabo Naranjito Orocovis Patillas Peñuelas Ponce Quebradillas Rincón Rio Grande Sabana Grande Salinas San Germán San Juan San Lorenzo San Sebastián Santa Isabel Toa Alta Toa Baja Trujillo Alto Utuado Vega Alta Vega Baja Vieques Villalba Yabucoa YaucoType of Organization Corporation Company IndividualAnnual Income An annual revenue below $1,000,000.00 Between $1 million to $5 million in annual revenue Between $5 million to $10 million in annual revenue More than $10 million in annual revenue More than $100 million in annual revenueCommittees Legislative and Governmental Affairs Committee Communications Committee (the representative must work in Marketing and Public Relations) Membership CommitteeRecommended by: “This application for membership must be recommended by at least 2 members of the PRTA, who should be either members of the Membership Committee or members of the Board of Directors.Recommended by I certify that I am authorized to complete this application and that the above information is true and correct. 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