Dear Prospective Association Member:

Thank you for your time and consideration in reviewing the advantages of membership in the MSSA. Currently, the Association membership is reaching 600 business locations. Membership is composed of gasoline service stations, convenience stores, automotive repair outlets, automotive specialty businesses, tire dealers, towing operators, truckstop operators and automotive body shops. Membership is distributed throughout the state of Minnesota with 63% metro and 37% greater Minnesota.

REGULAR MEMBERSHIP-Metro: This member is located in the ten-county metro area. Dues are $415 for the primary location. This member, according to the by-laws, has full rights to vote and to hold an Association Board seat.

REGULAR MEMBERSHIP-Outside of Metro Area: This member is located outside the ten-county metro area. Dues for the primary location are $355. This member, according to the by-laws, has full rights to vote and to hold an Association Board seat.

ASSOCIATE MEMBERSHIP: This member is considered a vendor to MSSA members. They offer products and/or services to the Association membership. Dues are $415 for the primary location. This member does not have rights to vote, hold an Association Board seat, or Legal Fund benefits. All other benefits of membership apply.

AFFILIATE MEMBERSHIP: This member is a business that would like to use our program(s) but not be a full member for specific reasons. Dues are $395 for the primary location. This type of membership does not vote or hold office and must have special approval of the Board of Directors.

MULTIPLE LOCATIONS:

$120 each for locations 2-5

$ 60 each for location 6-plus

Note: All members may participate in any of the Association’s programs. The only exception being that Associate and Affiliate members may not participate in the MSSA Legal Fund.

Review the benefits of membership. You will see it does not cost to belong…it pays!

MEMBERSHIP APPLICATION

As a member of the MSSA, I/we pledge to maintain loyalty and aggressively pursue the Association objectives; hold inviolate the confidential relationships between the individual members of my Association and myself and the confidential information entrusted to me through the Association office; exercise and insist on sound business principles in the conduct of affairs and agree to abide by the by-laws of the Association. It is my understanding that as evidence of my membership in the Association, I will be furnished with a display emblem of the Association. The emblem shall at all times remain the property of the Association and may be displayed during the entire time of my membership. I agree that this emblem will be used for no other purpose or by any other than the one described in this application. I agree, upon termination of my membership to remove all Association emblems from public display. The Association reserves the right to cancel membership for just cause.

APPLICATION FOR BOARD APPROVAL

Please print this form, fill it out, and mail to us with a check for membership consideration.

___Metro*-Selling Gas $415 ___Metro*-No Gas $415

___Greater MN-Selling Gas $355 ___Greater MN-No Gas $355

___Associate $415 ___Affiliate $415

Secondary Locations

___2-5 Locations $120 each ___6 Plus Locations $ 60 each

*Metro includes the following counties: Anoka, Carver, Chisago, Dakota, Hennepin, Isanti, Ramsey, Scott, Washington & Wright.

Firm Name: _______________________________________________________________________

Address:____________________________ City: ______________ County: __________State:_____ Zip: _______

Corporate Billing (if different from above): __________________________________________________________________

Phone: ( ) __________________________________ Fax: ( ) ____________________________________

Federal Identification #: __________________________ State Unemployment #: ____________________________

Owner Name: _________________________________ Partner Name: _________________________________

Spouse Name: _________________________________

Home Address/City/State/Zip: _____________________________________________________________________________

Home Phone: ( ) ___________________________ Home Fax: ( ) ________________________________

Sponsor Name:_______________________________________________________ Sponsor SS#_________________

Applicant Signature:______________________________________________________________________

Date:__________________

email address:________________________ website:____________________________

Please check ( ü ) all areas that represent your business.

(Use N/A if not applicable to your business.)

Gasoline Brand ____________

_____ Direct Supplied - Dealer Tank Wagon direct from Refiner

_____ Jobber Supplied - Independent Marketers, Non Refiner

Non-Oxy Premium _____ (Do you offer for sale?)

Convenience Store _____

_____ Quick Serve Restaurant

_____ Co-branded Food Service

(Brands_____________)

Auto Repair _____

_____ Number of Bays

Car Wash _____

Conveyer_____ Tunnel_____ Full Serve_____

Towing _____

_____ # of Trucks

Specialty Services _____

_____ Alignment

_____ Body Shop

_____ Exhaust

_____ Oil/Lube

_____ Tune-ups

_____ Other

# of Employees _____

_____Full-time

_____ Part-time

Open 7 days/week _____

Open 24 hours _____

Insurance

Workers Compensation

Carrier _______________

Exp date _____________

Business Liability Insurance

Carrier _______________

Exp date _____________

HealthInsurance

Carrier _______________

Exp date _____________

401k or Employee Pension Plan_____

Carrier _______________

Tell us a little about yourself for the MSSA Newsletter:(How long have you been in business? What makes your business/location unique? etc.)

__________________________________________________________________________________