Regular Member Application

Please fill out the following information and click the submit button. "*" indicates mandatory fields.
*First Name
*Last Name
*School Name:
Email
*Verify Email
*School Address:
Address2
*City
*State
 
Toll Free Phone:
( )   -
Main Phone:
( )   -
Fax:
( )   -
Website Address:
Chief Executive Officer or President
*Primary Contact?
Yes No
*Phone:
( )   -
Email:
*Admission Director
*Phone:
( )   - Ext.
Email:
*Recruiting Director:
Phone:
( )   - Ext.
Email:
*Date School Was Established:
*Number of Years In Business:
*What State License(s) Does The Organization Hold?
 
*Is The School Organization Accredited?
Yes No
If Yes - Please List:
Names and Titles of Other Management Officials Who Will Participate in CVTA Events:
How Did You Learn About CVTA?
What Is Your Primary Reason For Joing CVTA?
*Please Describe Your Commercial Driver Training Courses Listing Weeks & Hours:
Who Recruits At Your School?
I hereby verify that all information presented herein is factual and current and that I have read and
*Date: