RETAIL COUNCIL MEMBERSHIP FORM

I hereby apply for membership in the Retail Council of New York State. My dues investment is based on the annual sales volume of my store(s) located in New York State. While contributions or gifts to the Retail Council are not deductible as charitable contributions for federal income tax purposes, membership dues are a tax-deductible business expense to the extent provided by law. It is estimated that 25 percent of annual dues will be non-deductible for federal income tax purposes due to lobbying activities.


Name

Title

Store Name (DBA)

Corporate Name

Street Address

City

State

Zip

Telephone

Fax

Email

Website Address

Number of Stores in New York

Type of Retail Store

Annual Sales Volume (NYS)