Membership Registration - Quality Texas Foundation

Your Name*
First Last
Your Title*
Your Email*
Your Phone*
Will this be a Corporate or Individual Membership?*
- Corporate
- Individual
Name of Corporation*
Corporation Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Corporate Membership Options*
- Platinum - $75,000 ($25,000.00 per year for 3 years)
- Gold - $50,000.00 ($16,666.00 per year for 3 years)
- Silver - $25,000.00 ($8,333.00 per year for 3 years)
- Bronze - $15,000.00 ($5,000.00 per year for 3 years)
- Brass - $2,500.00 per year
- Copper - $1,000.00 per year
- Zinc - $500.00 per year
Individual Membership Options*
- 5 Star - $1,000.00
- 4 Star - $500.00
- 3 Star - $300.00
- 2 Star - $200.00
- 1 Star - $100.00
Total
$0.00
How would you like to submit your membership payment?*
If paying by credit card, please select that option below and complete your credit card information. If paying by check please make it payable to Quality Texas Foundation and mail to 201 Woodland Park, Georgetown, Texas, 78633.
- I'll pay by credit card.
- I'll pay by check.
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
To prove that you are human please spell out the answer to seven plus four. Once you do that you will be able to submit this form.*
Phone
This field is for validation purposes and should be left unchanged.