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Please mail or fax to:
9100 Purdue Rd., Ste. 200
Indianapolis, IN 46268

Fax: 317.387.0999

IAMOA Membership Application/Renewal

Applicant Profile

Company Name: ________________________________

Company Address: ________________________________

Phone Number: ________________________________

Fax Number: ________________________________

Email Address: ________________________________

Web Site Address: ________________________________

Please indicate other memberships:

___ AMOA

___ NDA

___ VNEA

Names of Owner(s): ________________________________

Other Contact Name(s):________________________________


Three references must accompany new applications. One reference must be an Operator:

1. Name:
Phone Number:

2. Name:
Phone Number:

3. Name:
Phone Number:

Please read the following information before completing this application. Be sure to include all the required details. The absence of any information may delay your acceptance. Please type or print legibly. Dues must accompany your application. All applications are subject to approval by the IAMOA Board of Directors according to the Bylaws.

Qualifications and Dues (Please check all that apply.)

All memberships are based on an annual period beginning January 1st and concluding December 31st.

___ New application

___ Renewal application

Membership status:

___ Associate

___ General Member

Nature of business:

___ Operator

___ Distributor

___ Other.  If other, please provide brief description:




Number of years in business:  _______

I am enclosing my dues for the following membership and understand that IAMOA will retain $50 to defray costs associated with processing this application if it is rejected.

___ $350 Operator

___ $500 Distributor

___ $500 Other

Operators, please check all which you own/manage:

___ Jukeboxes

___ Pool Tables

___ Pinball Machines

___ Video Games

___ Darts

___ Foosball Tables

___ Redemption Counter

___ Cranes

___ Vending

___ Kiddie Rides

___ Other.  If other, please provide brief description:





As a condition of my membership in IAMOA, I do accept and endorse the Bylaws and Code of Ethics of IAMOA and also certify the information on my application are true and accurate.

Authorized Signature (Owner)


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