New Jersey Food Council

30 West Lafayette Street

Trenton, NJ 08608

Phone: 609-392-8899 Fax: 609-396-6571

E-mail: njfoodcouncil.com

2009 APPLICATION FOR ASSOCIATE MEMBERSHIP

(Please print or type.)

Date:________________

Please enroll my firm as an Associate Member of the New Jersey Food Council. Total New Jersey sales volume of my firm for the preceding 12 months was __________________.

Signature: ____________________________________

(YOU WILL RECEIVE AN INVOICE FOR YOUR MEMBERSHIP DUES BASED ON YOUR SALES VOLUME FOR THE PRECEDING 12 MONTHS AND PRO-RATED ON THE FOLLOWING DUES SCHEDULE UNTIL DECEMBER 31^ST OF THIS YEAR.)

FIRM NAME: __________________________________________________________________________

ADDRESS: __________________________________________________________________________

CITY/ST/ZIP: __________________________________________________________________________

CONTACT(S): ____________________________________ ___________________________________

(Up to2) Name Title

____________________________________ ___________________________________

Name Title

PHONE/FAX: ____________________ ___________________________#NJ EMPLOYEES: _______

Phone Fax

E-MAIL: _________________________________

CHECK AREA OF BUSINESS:__Manufacturer/Distributor__Wholesaler__Service Company__Broker

BRIEFLY LIST PRODUCTS MANUFACTURED OR REPRESENTED; OR TYPE OF COMPANY:

________________________________________________________________________________________________________

________________________________________________________________________________________________________

DUES SCHEDULE SUGGESTED

SALES VOLUME DUES PAC CONTRIBUTION

0-5 Million $ 740.00 $ 50

5-10 Million $ 971.00 $ 50

10-15 Million $1,945.00 $ 50

15-20 Million $2,427.00 $100

Over 20 Million $3,379.00 $100

Contributions or gifts to NJFC are not deductible as charitable contributions for Federal Income Tax purposes. However, they may be tax deductible as ordinary and necessary business expenses subject to restrictions imposed as a result of association lobbying activities. NJFC estimates that the nondeductible portion of your Dues-the portion which is allocable to lobbying- is 15%.

EIN 22-1863080

THANK YOU FOR YOUR SUPPORT